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Date� �S�/ ;`.. _�_ <br />AppllcetionFOF., TO POSTING �D ��/q� <br />PUBLIC WORK� PERMIT <br />O <br />O <br />O <br />Print or Type Only = o o � � o a* <br />4. , <br />O O O �a wj±�l di <br />�� Cy N CU W In +Pr C•.I �O <br />�f7�i�t�r n f �iOS�- �'� , <br />_�=r ��7`� �fii�o� C� ti�n l� '" <br />Owner MaiNn A �a � t� �j N N. y � i� ���iP <br />9 �r 000�0�-o�3oi--��-z+on <br />� � 0p QO GLp W Ofi33 q J <br />_ � 7CykYk33t 03CUI [n ]LOO_d a M <br />Mailing <br />Deacribe Proposed Work <br />Project Addreas (if known) Z92�" <br />City <br />Pu011c Worka Perm�t s n— s�9 �� <br />emy. osa�. s <br />PUEI�c Worka Fee <br />Tolsl Fea S <br />Laes ApP� Fee PaIO S <br />mIp�CQAue S <br />� m O �'�'O'<1T� J.� <br />��� <br />99/�9 77/ S99 9 <br />� �� .�,- Phone <br />'i- 4' 41 <br />o ai � <br />Phone <br />/�_ 'i /. <br />Attach four (4) cap(es of plens for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Canterline of street <br />• Outline and dimensions o( all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Extatinp end proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inapection shall be made 24 hra. tn advance - phone 258•881 O. <br />2. All work ahall be performed (n accordance with this permit and current City of Everett Design and Conatruction <br />Stenderde and Spec(flcatfona <br />3. Call Location Underpround Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800�4Qq-5555. <br />f� fl��c- luv, ;f �nof i�cic.d.�� _ <br />�4r�o�,r'cu�0i��) 7�0 6e c/pne <br />PPr �C� r� Q��.ra v�c/ 6y f/x f�c�6l.i cvor.C-.r deP� <br />on //-7/ -r%o 4�0� v�v�JeGr a„ �O- Z�-9/ <br />2 � <br />,,,,,. <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA g8201 <br />Phone: 259-8810 <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of ihe improvement or other right•ol-way use hereto <br />applied for and further ag�ees to remove same upon notice from the <br />City and to repiace public property damaged thereby. <br />Il���ql <br />Signa re o Applicant Date <br />WORK THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />