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� <br />. . . � a. ,... , r . .I ,�+fy�l�e,� . �. Si+�w. � i <br />S' <br />Application For �: <br />PUBLIC WORKS PERMIT <br />PUBUC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 259-8810 <br />o�� I — Z –7 — �i � <br />Public Works PertnH N / O� � <br />Building PertnR M <br />NPE OR PRINT ONLY <br />T� POSTING Nov_�OUu P�b�����F�: ss-z �a <br />��-,,.. �'eP%c 7.1�`11Q S. �ns.J�+S �.,��. q803� (zoC�� -7-1(r-U91 i <br />nwnnr Mailinp Address City Zip Phone <br />S <br />Applicanl <br />Describe Proposed Work <br />Mailing <br />L <br />r <br />PROJECT ADDRESS (if known) �2 �5 - <br />I pio/�+c 9 a <br />��— <br />�(/i�c�in q <br />_._��;�;y <br />� <br />Attach four (4) wpies of plans for proposed work - Oraw to swle and note the following it applicaWe: '„�NER 41 RL .� x? <br />•Property Lines 'Outline and dimensions ot all existing and proposed sirocfur_s on ihe lot •Existing and pi6pdf1�l,lAilNielf�,: . a'� <br />'CeMerline ot sheet •Indicate North •Show any proposed grading change� •Sbow measuraments �' �'. ' ���� . . _ . -�� <br />n:r�_i' a'.�_ "o <br />. . . . � � . � u � i � _ <br />PERMIT CONDITIONS: <br />i. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertortned in accordance with this permit and current Ciry of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEf� 1-800-424-5665. <br />/� �G`,C Z�a ,JC �✓Ohc OG» -�i/)�ltov��✓ ��4hS' <br />d4�¢ � <br />3 –7 9� � �' <br />�7, Q �OG'//'o�-/�G'nCe �Ci4�4n�eL i0�' �ryc <br />S�✓''LG / �/r1�0/'OYCir1Gh /f /7')VS� .O� iJtU�hT <br />i <br />�/-� 6��-c �u:l�:,S �vc�...� fs cz �-e /S-Ic% • <br />m <br />� <br />O <br />� <br />� <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITiONS � <br />��-� The undersigned owner/applicant hereby agmes to hold and save harmless <br />� h _� /� �� 9 7 the Ciry of Everefl from eny and all claims for dameges, costs, expenses, or <br />Dat causes o1 action that may arise because of installatbn and maintenance of <br />the improvament a other righhof-way usa here'o appliad tor and further agrees <br />. to remove same upon notice from the Ciry and to replace public property <br />damaged thereby. <br />PINAL INSPECTION Date _ <br />MProved as Constr�cted K �p ( e � ,� -lz • 9 g �r� .��� � �ji I �� % <br />Signature oi M t Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATf PERMfT IS ISSUED AND THEREAFfER IS TO 8- DILIGENTLY PURSUED TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY iHE CIN UPON ANY STOPPAGE OF WORK ON 7HIS PR0.IECT OVER 90 DAYS DUHATION. <br />