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c��v <br />� � � <br />b �3 N <br />tq <br />y z H <br />�.� z <br />� N b <br />N H <br />f�9 O � <br />H O <br />O N <br />z n o <br />" °° R <br />�• <br />zy� <br />� H y <br />D v1 <br />RdN <br />� "� <br />2 H N <br />H O N <br />� �����.. <br />�� � <br />Date � n-s-47 <br />App�ica�ion For <br />�`` pUBLiC WORKS <br />Print or Type Only <br />Pavless Druas <br />Owner <br />A1 kosenzweig <br />Applicant <br />Describe Proposetl Work _ <br />Proiect Address lif known) <br />Puol�c Yloixs Pa�mil • " � � � — - <br />emo oeo�. • - 38271 <br />F E R M IT I P°�°"v�„' "° 5 <br />To,a� ��o <br />LCss FpOI Pee Pa�E S'✓ �—_ <br />Balanca Due 5 — <br />Ciiy <br />251'7 - Slst PL <br />Address <br />98203 <br />CD2- �'�z. ypi/8� / <br />Atlach lour (4) cnpies of plans lor proposed work - Draw to scale and note � CQo11eWine ol tPeeit able: <br />• Properry Lines • Indlca:e North <br />• Outline and dimensions of all existing and � Show a:y proposcd grading changes <br />proposeds�mcturesonihelc • Show measurements <br />• Ezisting and proPosed �_Slities <br />355 <br />Phone <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 253•8810. <br />2. All work 5hall be pedormad in accordance with ihis permit and current Ciry o! Everett Design and Conslruction <br />Standards and Specificalions. <br />3. Call Location Undorground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•555 . <br />��` �` �r+ / � (/Ccizcc✓�+-ct/ ''r' �� /2t�QLlc,u�,u-.�r <br />//���L!'��G��GO'�-�%' lGEI'C'7.N�I !� b �f <br />� v�- n/'C>inia,ute �SS<S�tCcfTn-tiFr'c�✓Yi•-ic�t7�S� 7or ln /�nan�hS. <br />/ <br />f�ic E�d a� GX h�nn%iJ� %hc 4��Citan-f ->�h�L� C��'�i.z'- �vrdvid� <br />� Sfrc� �n�ro✓un�.��s or disco.,f.n✓� f'he <br />f�� codc ��� �,-,.,� <br />s,f� vse, J <br />/1 ��,, �O .cii.i hoi''f� f� t� h <br />d� <br />'M' 1 � yL _ ����.i S/,fl'cCI ll(' �7�'�l1Z�l;. A�(.t7. <br />J�C[ �� LifafC �n R�+c2 <br />PLan �,,, dto�er fu i/ati <br />' � ,���Ov.Yi` Cnv Z"� '�"�� � � i W�-i�i ✓G'{i.GLZS uSinf <br />L'_ .,�nS fo S�a[k wr�/�c�t/� /ntcr�G�'�'✓` <br />i,o/. ---- <br />-(!� QiS�L 2✓Q� <br />,� <br />qpproved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl. WA 98201 <br />Phone: 259-8810 <br />tu fh� Snv-f/i, <br />�� <br />y <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned nwner/applicant hereby agrees to hold and save harm� <br />less the Ciry ol Everett from any and all claims for dama9es, costs. <br />eapenses, or causes of action lhat may arise because ol inslallation <br />and maintenance ol �he improvement or other ri9hl�ol�way use hereto <br />applicd for and lurther agrces to remove same upon notice Irom the <br />City and to re lace public property damaged 1 ere�y. <br />' �.1. � �C �-' � --� � / j , 7 �Z � <br />Sii nature ol ApPlir�an � <br />Date <br />WORK AU�HORIZED Y THIS PE MIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS' SSUEA AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLcTION. THIS PERMIT MAY BE <br />CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 30 DAYS DURATION. <br />�� <br />