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Date�2�3"� <br />Applir.31i0n FOr <br />PUBLIC WORKS PERMlT <br />Print or Type Only <br />ny <br />7 �� `�:�" �� <br />cnv z�� <br />� <br />n„ox- Yia... r�.., 1I ' �I�- �'�I <br />N�nq fan� . _�_f c�_l��- 1 <br />-- -- -- _ ------- __ <br />,,,,,.�„,,,.,,t �..,. <br />r,.�,,�,.,. s_.—._ _ <br />«„ a;,,,� �a� �.,�„ s __— <br />;, ^ ��--- <br />E�,p�,,.�„� s � � _- <br />ApPliCant MailingAddress -----C�q' Zi - ���- ��- <br />P hune <br />Descnbe Prcposed Vvo�k _ .__ c 7� <br />Pro�ect Address �.1 knownl <br />Altach lour 141 co� ies 01 plans lor proposed work � Dmw to sr.ale and nole Ihe Iollo�.ving as applicable. <br />• Property lines • Cenlerline of slreM <br />• Out6 ie and dimenslons ol all existing and • Indir,ate North <br />propcsed structures on Ihe lot • Show any proposetl gradmg changes <br />• Ezis�ir g and proposed utJities • Show measuremenis <br />PEFiMIT CONDITIONS <br />1. All calls for inspectioi• ehall be made 24 hrs. in advance - phone 259•8810. <br />2. All wmk shall be pedon�ed in atcordance wilh this permit and current Ci�y ol Evere�t Design and Construction <br />Standards and Spe�i;;: '�cns. <br />3. Call Localion Unuerp ' b.:vice 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� /(1-��llf : -�, ��3GC1 Z• •� �/� c l..:: �J C�<t :�'� , <' � .R �c� _ Jl�.� � at. <br />�� e � <br />�L��Y�'� /-C�LI /y.c�� /C �r �� '� �r: �i �- ��c't �(�r�� <br />.��.,���a�.�I �.3�� �,,u/' �.�°c^,: . <br />✓� <br />�. <br />Cf�z�-14�1� �ne« /�Zcc-ti�t-�.r., �F i r• C .j_rr .t'<,, �� �v,��� �� <br />� r �� <br /><[e��� 1 +11--Cj r� 1.-i� J 7 ` • <br />��' �J... J . <br />CD7Z�liLCCri T y S S�LG.C:G� [{� ���P2<KCO � [i'LCULG(l�r.�/ <br />Cc�ZL c�� .io .c`� 64 �-„�t0. �'� <br />_-1L.:G, :-��-�,•-„/•- �'/(� -:5'% <br />��pProved lor Co �udion Date <br />�%��,�— �'-3-J, <br />� <br />FINr�L INSPECTION Date <br />App�oved as Conslrucled <br />everett PUBLIC WORKS D,':PARTMENT <br />� 3200CedarSlreel <br />[verelt WA 99201 <br />Phone:259�8810 <br />■� <br />� <br />r�A <br />V♦ <br />O <br />a <br />ACKNOWLED3EMENT OF GONDITIONS <br />The untlersigned owner/applicant hereby agrees to hold and save harm- <br />less the Gty ol Everell Iron any and all claims lor damages, costs. <br />expenses. or causes ol act�on that may arise because ol installalion <br />and malnlenance of ihe im�novement or other nght�ol�way use hereto <br />applied lor and Iwther agrcea to remove same upon nolice Irom Ihe <br />City and �o replace put�hc prop�?rty d� magetl �hereby. <br />(�G`�(./C. i i�.'1/1 L/ / f i'—�— <br />Si9naturc ol Applicanl Datc <br />WORK AUTHORIZED BY iNIS �'f.r7Mli MUST BE STAFTED WI7HIN <br />180 DAV$ OF DATE PERMIT I, I:iSUED AND THEREAFTER IS TO <br />BE DiI.IGENTLV PURSUED TO f,OPo1PLETION. THIS PERMIT MA\' BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION <br />