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i <br /> � <br /> � <br /> Date��{__i.,1_i�'_l ��„�,��<<•,�,�,�,�,mp��.� � <br /> APPlir,alion Foi F����n m•r� . __p:������ I <br /> PUBLIC WORKS PERMIT °,�°-;�,�IYl1Pe s=---- --- ..__ <br /> «...�„� �,�P.,,� s_ —- <br /> Print or Type Only pn1""`°°"" s G�� — <br /> ��� �:��ad ,���n �� .��- s� �� 4�8- �3�- y.��l . <br /> � Uwni� Maihng AAdress City 2�p Pnone <br /> -+�1�1� — <br /> � AppJcant Mailing Address City Zip Phone <br /> � Describe �roposeA Work =�-L�l � � � �� �� C lI— L P' <br /> Prc;sct Address lil known) � �� � — � C�S�N� �v/, � <br /> � Atfach lour(41 copies ol plans lor proposed work� Drnw to scale und note Ihe lollowing as apPlicable�. � <br /> • Property Lines • Centerlme ol street � <br /> - • Oullme end Aimensions ol all exlsling and • Indicale North <br /> proposed structuras on the lot • Show any proposed gratling changas <br /> , • Ezisting&nd proposed ulil0ies • Show measuremenis � � <br /> DO NO7 WRITE BELOW THIS LINE I <br /> �, PERMITCONDITIONS O . <br /> . 1.All calls lor Inspection ahall be made 24 h�x.in advance•phone 259•8810. � <br /> - 2.All work ehall be peAo�med in accordence with this permit and current City of Everett Dealgn and Canstruction <br /> Standerds end Specilicatlona. <br /> � 3.Cell Lxellon Undarground Service 48 hre.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> y r.��� � '/_-' .��c«.�a�:L ��;<;,�,��,�.,f;� .�<< ,/ �_,Q2� O � <br /> � , . <br /> ! Lc��j .Lf=�+o!„�'�,;v6. <br /> � .�PI+,�?,.P� fCc-:/ � yrct .f�:.� a� l�JCc-`E't(�., , C.t'tr_ f!', � � � <br /> � /J / �� i <br /> � a-"a-" ,�.a,Qf�le� O�Le�,.e..do� ��oL c<'�y s�r.,4n'c�.�'.�- �,30! O . <br /> 7 <br /> lC. /CP�I�'2�' �j('Gd�[•ir �>ltl.���Z:C.�1� ..Lc' I1E//L�tA'I�ZL(i./ ��f CL�Ef�Lt>I��, � <br /> 7, l���c P.cl•v, z+-: � , <br /> /Ln-r''�>r� . ..��G�.1G„ a_-,Ksl��-z. ?Cc �o <br /> ' � �� e�.zcc,� . <br /> �<<��"� '�u"-� `t`K'�'-'"�l� �� '����� � ACKNOWLEDGEMENTOFCONDITIONS <br /> The undersigned ownei/applicanl hereby eprees to hold and seve harm- <br /> less Ihe City ol Everett irom any and all claims lor uameges, cosls. <br /> ' eKpenses, or cause: ol aclion Ihet may anse becausr ol installalion <br /> - ����?/ /� 9 and mainlenance ol lhe improvement o�other righl-ol�way use hereto <br /> npplied lor end lurlher aqrees to remove same upon notice irom the <br /> Approved onslruclion Oate City anA�o �eplace pubGc Cropert damaged Ihereby. <br /> �� � � � � 3�/ �C-(� '� r/' <br /> FINAL iNSPECTION ' Dnte .//!- ` ��� <br /> Approved es Constructed Signalme oi ppGcant Dale <br /> everett PUBLIC WORKSD�_PARTMENi tYORK A HORIZED BV THIS PERMIT MUST BE STARTED WI7HIN <br /> � 3200Cetlr.�Slreet 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO � <br /> Everett,WA99201 BE DILIGENTL" PURSUED TO COMPLETION, TNIS PERMIT MAV BE <br /> Phone�.259�0810 CANC[LL iD BV THE GTV UPON ANV STOPPAGE OF WORH ON THIS <br /> PROJECT OV[R 90 DAVS DUPATION. <br /> I <br /> i <br /> I <br />