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Date � ��� <br />Appilcation FOr <br />PUBiLIC WORKS PERMIT <br />Print or Type Only <br />� <br />PUEIie Wo�ke Permit � _�e / �' <br />amc. oaa�.• <br />Puslie Works Fea � <br />Total Fee s —� <br />Lans Appt Fea Pe�tl S_�� <br />Balance Due + <br />l',�n�,� � � �� /-'��v� y sc�-? i� r- �b`/a 2 3��- /��3 <br />7Io Phone <br />Describe Proposed Work <br />Pro�ect Address (if known) <br />(D -Z� <br />D� PN. <br />�c��� J� .l7,C)/—'� �s . <br />.—Z3�- �� CO2� <br />,,� `;o%niG G.�/Lf� • <br />��� <br />� /�I91 � W"�, <br />S,v,/�'� <br />Oraw to�scale and note the following as <br />• Centerline of streel <br />�g and • Indicate North <br />• Show any F�oposed grading changes <br />• Show measurements <br />�e 24 hrs. in advance - plione 259•8815. <br />xdaoce with this permit and currant Ciry of Everett Design and Construction <br />> 48 brs. before you dig. TOLL FREE N�BER 1• _ 0•424•5555. <br />� f �'�[� .iOti D'� / �„_ <br />r �•.t [Y S � GL ,c � O �F <br />�o�� �� � � '" ������i�-•- � P <br />Q ��-�ir � � <br />�mn � � <br />� � / <br />S. �-1i7�/ay�a( Llro.�o1� �'!�i /i%P�eSvrPS <br />r� �u,',-�e� %� r�►-o,-�� �d� �-°' `T� s <br />��� - <br />C t /O�S <br />(�. ,0/T�'fi� f�i<<rn1G <br />���� ���� <br />, <br />FINALINSPEG�wrv V /� <br />Approved as Conslructed �J <br />everett PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-BB15 <br />�v�-��� ''��L <br />Date <br />Date <br />,- <br />li'if"'P�fT�C.�✓ <br />OfC(/r/-/�1 � <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and s. ve harm- <br />less the City of Everett from any and all claims lor damages, costs, <br />ezpenses, or causes ot action that may arise because of inslallation <br />and mainlenance of lhe improvement or olher righFof•way use herelo <br />applied for and further agrees to remove same upon notice Irom Ihe <br />City and tbreplace public property damaged thereby. <br />�� /,a �� � <br />� � a�e <br />Sign ture of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST E STARTED WITHIN <br />180 DAYS OF DATE PEfiMIT IS ISSUED AND THEFlEAFIER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TH[ CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />� <br />z <br />0 <br />� <br />� <br />m <br />.. .. <br />--i -n <br />.. �--� <br />N 2 <br />0 <br />m <br />co <br />mo <br />-i c <br />O 3 <br />m <br />_ -S.I <br />m <br />.. <br />.o z <br />� <br />a -� <br />r x <br />.-� .. <br />� H <br />1 <br />o� <br />�a <br />�m <br />x <br />m �-. <br />N <br />v <br />�m <br />c �n <br />3 1n <br />m <br />z c� <br />�r <br />• m <br />n <br />A <br />� <br />_ <br />a <br />z <br />� <br />x <br />� <br />N <br />Z <br />0 <br />� <br />� <br />m <br />