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i <br /> �� � <br /> H <br /> O x ' / <br /> � H [n �j� <br /> H� �i Date 6-1-9z TO PQST�lN�...__3�� n�m��w,...r.,m��. .L' Z <br /> �e e • <br /> y "'� ApplicationFor cao.oeo�.• 76887 <br /> � � �, PUBLIC V4'ORKS PERMIT <br /> vue�¢WorbFee S <br /> Totel Fee <br /> � xo. � Lc¢sAo>�FeePa�J S Ju -� . <br /> G M a Pfinf Of TypB Oflly 3aiance�ue S.�S�- � <br /> � �� � <br /> L)v � <br /> Z � � Wesley Ruth 2128 Broadway Everett 98201 258-6793 <br /> �" t'L Owner MailingAddress Cdy Zip Phone <br /> MH <br /> g�' <br /> o C ai Owner -- , <br /> ��'�+ Applicant Mailing Adtlress City Zip Phone <br /> y w addn to existin auto sho <br /> y �y Describe Proposed Wo�k g p <br /> W <br /> Proiect Atldress lii knownl Z128 Broadtaa � <br /> Atlach lour 14�copies ol plans lor proposed work-Draw to scale and note ihe tollowing �s applicable: � <br /> • Properly Lines • Centerline ol street /A <br /> • Outline and dinensions of all existing and • Indicate North M� �. <br /> proposed structures on the lot • Show any proposed gradin�changes ��. <br /> • Existin9 and proposed utililies • Show measurements � I <br /> DO NOT WRITE BELOW THIS LINF r I . <br /> '�' PERMITCONDITIONS v <br /> 1.All calls for inspection shall be made 24 hrs.ir,advance•phon=259•t3t!�0. � <br /> � ' 2.All work shall be pedormed in accordance with this permit and curreM�:-';y ol Everett Design and Construction <br /> � Slandartls and Specifications. � <br /> 3.Call Location Underground Service 4B hrs.belore you dig.TOLL FREF.NUMBER 1•8Q0•424•5555. � .� <br /> e� ' � � /`il./-c-.+E/ 4:.� s�,..S- 4'�nc�/ �C2r+"l! lo'� JiC(, 7ri.:,..�j` �1P /JA.C^id O � <br /> I� �/ � � i <br /> '�' .�c`r:Li�/ 4• �l�zuri�Muc;,.' .•� � � c/ !'la9J G� t[;i�;�..��.Cz�t :. 5� „ <br /> L v �1 ` cy G�[,r.714•_�� /?orn . w <br /> a� � y1 � <br /> ��� ,j � r ' �.(/1X� �- f.;.._ —�.c. ' �'•�� /�ILc.� / i�.0 (�L��'�/)-E.":.�.f� � <br /> �w�"�ji ,; <br /> �_� ,��� ����� �t���.� � �..�����-. � ; � <br /> '_ �� ��/ �,�y- � <br /> �� (�� Cc1�lj/CaA=C' Se«v�_✓ lc�.1 S/LO"'^��`� CNv /�t"o-f � ����-�,.: � <br /> ' O <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> v <br /> The undersigned ownedapplicant herehy agrees to hold 3nd save harm� <br /> � less the Cdy ol Everett Irom any and all claims tor damages, costs, <br /> ' / / / � ekpenses, or causes ol action that may arise because ul installation <br /> L'7�( _ /.� ,(� /� G: a l' rZ and mainteaance ol the improvement or other rigM-ohway use hereto <br /> � 1���� dI� �y" _ � applied }or and lurther agrer.s to remove same upon notice hom Ihe <br /> Approved lor C nslructiom Date City apd to�eplace p �ic p operry darnaBed Ihereby. �. <br /> G'y �_ � i <br /> ��%'��_ t- � - 3 -7 3_ � - 7 i <br /> FINAL INSPECTION Date ' ' � �L— <br /> Approved as Constructed S�ynatu 4f ApPlicant �a�� <br /> WCRK r `fHORI'ED 9V l-HIS PEFMIT MUST Bf_ . /1�7 ED WITHIN <br /> PUBLICWORKSDEPARTM[NT 1B0 DAYS OF D?TE PEHtdIT IS ISSUED AMD TH°Fic'AFTER IS TO <br /> 3200CedarSireet BE DIUGENTLY ?URSUED TO COh1PLETiON.Th•� S PEHMI� :dAY BE � <br /> Evercit,WA98201 CANCELLED BY 'NE CITY UPON ANY 5'fOPPi:F OF WOFK i)N TN1S <br /> Phone:259-P�10 PROJECT OVEF 9U DA�.`,�URATION. <br /> i <br />