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�� � <br /> �H <br /> '�y � TO POSTING__L_ <br /> ?/is qZ 2 l6 <br /> H � .[—'/� �� Puoiic wo�xa Permn+ <br /> ` � . D'ate� eie9 oeoi • <br /> �3 �o qpplicalion For <br /> PUBLIC WORKS PERMIT P"°"`"'°"SeB s <br /> �y roiair�e <br /> �!~A N <br /> ��� �ass nooi.Fea Pa�a $ ��—� <br /> dalence0uo g-�� <br /> p��� Print or Type Only UD�-.3225�0/ 783/ <br /> tc <br /> N,� SP��[� L�.f7 /r8/ZS 3G_ Y- `I650 <br /> ~y� ���QC � er�scn�SJ��G. /2733 LK. C/T ��, c, v zip Phone <br /> Owner Mailing Address <br /> 7.H <br /> �HH (+ ! / 1 �- � h <br /> �� ~ � J�1ME 5��7— !!/�r Y^�n Gc�lr �Ci'c LC)�t /���3 Phone <br /> � y alling Address City Zip <br /> . � � APPlicant ' <br /> yVi ii' .S'fDr�+� .vY'<ri - .L�s�aLL C'a�c% B�sin . <br /> O tN Describe Proposed VJork <br /> _ . j <br /> -- J <br /> ! _ __.. � <br /> F <br /> 59/7 - EI/<'rn r�en (�/2i � <br /> project Address(il known) � <br /> Attach lour(4)copies oi plans for proposed work• Draw to scale a�d nole Ihe following as applica�le: � <br /> • Property Lines • Centerline ol street <br /> . • Indicale North <br /> � '�1 - • Outline a�d dimensions of all existing and � Show any proposed grading changes <br /> proposed siructures on ihe lot � Show measuremenis M <br /> ' ' • Existing and proposed utilities W <br /> � DO NOT WRITE BELOW THIS LINE � <br /> ' ' PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 1�' 2.All work shell be performed in accordance with this permit and currenl City of Everetl Design and Consiruction <br /> Standards a�d Specilications. � <br /> '�1 � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•555 . <br /> ��� 5� l.C,�nl.: ,� be. �m.,�c/� �..,�. aPp-zm�4 ow S-�i y z O <br /> ' 7 u <.`'i G�kTllvv Q�.e�a/�nwn7� <br /> '�' fj(/ Z`i�'eJ �,ti"xc�� � �f � <br /> / <br /> �' <br /> � � <br /> �I1 O <br /> 1 � <br /> - a <br /> ii <br /> `__ ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneqapplicant hereby agrees to hold and save harm- <br /> less the City ol Eve�etl hom any and all claims for damages, costs, <br /> ezpenses, or causes ol action Ihat may arise because ol installation <br /> � /,C9�I, and maintenance oi Ihe improvemen� or olher right-of�way use hereto <br /> GL/(� ,l��'/�Z`i/� `� �S �Z applied br and furlher agrees to remove e upon notice irom the <br /> Approved lor Constru ' a�e Ciry and to replace public pr perty dama ed ih re6y. . <br /> ������--� S r�z ' " - <br /> � ",-, <br /> FINAL WSPECTION Date Date <br /> Sgnature ol Applicant <br /> Approved as Constructed yypRK AUTHORI2ED BY THIS PERMI7 MUST BE STARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br /> 3200CetlarSireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98207 CANCELLE�BY 7HE CITY UPON ANY STOPPAGE OF WORK ON Tf115 <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />