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C�7 M � <br />O � x <br />9Ht~i� <br />Y <br />K � n <br />H �1 <br />"O� H 'O <br />V] H <br />H <br />xo <br />OHd <br />��g <br />n� � <br />t"y� <br />ri y <br />g�' <br />� <br />��� <br />�� <br />� <br />1 <br />I �� <br />L� <br />DateL2���`t 3 <br />Application i or <br />PUBLIC WOF�KS PERMIT <br />Print or Type Only <br />Mailing <br />Zip <br />PuoLcwo.kePermno �� � � /_ <br />�iap. Deo�� • , <br />Puol¢ WoA� Fee � <br />Tobliee s <br />le�enoo� FseP�iO 6 <br />e.i.nce n�e S � �' (= <br />Phone <br />DescribeProPoseGWork L�/�}iTi- AV�1 YG�L��%CCC,�Gyr�nlC /�CA(f����Cti/ 'f7a1�7�ii= <br />/ <br />Project Address (il known) <br />Attach four (4) copies of plans lor proposed work - Draw lo scale and note the following as applicable: <br />• ProPerlY lines <br />• Outlir,e antl dimensions of all existing and <br />proposed structures an Ihe lot <br />• Existing and p�oposed utilities <br />�� <br />• CeMerline ol sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMITCONDIilONS <br />1. All ca�ls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shsll be pertormed in acwrdance wilh ihis permit and current Ciry ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER �•800•424•5555. <br />� ciecc,yy ,a�a.l%' �e !�u <br />�� . (.�� � d�a«��r� <br />a��. -c���z�� <br /><<.Z'�'clZ� �� <br />� <br />'�,���:-r� �/�/�� <br />Approved for Constru�ion ate <br />�.C<.� �-�o -j� <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />�PUBLIC WORKS DEPARTMENT <br />�� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259�8810 <br />,-�f.i(' �',�� !�' ��� S?. <br /><I 6' <br />ACKNOWLE�GEMENT OF CONDITIONS <br />w <br />� <br />_ / <br />Z <br />� <br />� <br />� <br />a <br />a <br />The undersigned owneUapplicant hereby agrees lo hold and sa�•c ha�m� <br />less Ihe City ol Eveir,p irom any and all claims for tlamages, costs. <br />expenses, or causes of action Ihat may arise because of installation <br />and mainlenance OI the improVemenl or olher fighPol-Way use hercto <br />applied for and furiher agrees to remove same upon nofice irom Ilu, <br />City a to replace p�blic roperty damaged Ihereby. <br />(.�-I.S- y � <br />ignature ol0,ppliC�fnt Date <br />WORK AUTHORIZED BY THIS PERMIT �dUST BE STARTED \4'I11iIN <br />180 DAVS OF OATE PEI7MIT IS ISSUED AND TIiEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PBRMIT 1.1AY B[ <br />CANCELLED BV THE GTV UPON ANY STOPPAG[ OP \NORK ON THIS <br />PROJECT OV[R 90 DAYS DURATIOH. <br />