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r- <br />�ate �/�•�� <br />PUBLIC <br />Print or Type Only <br />Application For <br />M/ORKS PIERMIT <br />� <br />Puhlic WorkS Pormlt s �✓' � /3 - <br />BICp. Dopl. • 3 � <br />PUEIit Works Foe <br />TalulFco S �� <br />LussApO� Feo P51tl $ ��� <br />Balance0w $��� <br />Describe Proposed Work ��/r%�r��Q� a'`�� 3�6� <br />v r7Pif'f%n2.!✓_ ��..l�_ -_,-.— <br />Project Address (il known) <br />c_ <br />Attach four (4) copies of plans for proposed work - Uraw to scale and note the following as cpplicable: �' <br />O Proparty Lines � <br />• Outline and dimensions of all existing and • Centerline of street <br />proposed ctructures on the lot • Indicate Norih <br />• Existing and proposed utilities � Show any proposed grading changes <br />• Show measurements <br />PERMI7 CONDITIONS <br />t. All cal�s for inspection shall be made 2a hrs. in advance - phone 259-ggi $. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before yc:� dir,. TOLL FREE NUMBER 1-$00•424-5555. <br />� �C c� �L(J'1 _ ,1J�c G�g/iL.+�sC�9�t-� mc.� �;• r�i �S — �7` <br />.�`�P.4 <br />���yG i'-yevyJ Ti96� �{ S!o or f3,4P�i✓�, i?�P'-Q <br />S vuJi✓�.�/i,4.offtCi?�JT /��oGNiX�ej+ T/fi�,— )'ff£ �v�c.J cO�fioEer.�ycJ' <br />/ <br />oiJ cr�e� �-�,- �A.�c c�JA �9•f'� <br />y � ��,e,R.Py ,?,r,o �v,u- ,r�'c <br />ij'c�Tir�t� 9�.,to �=L��tcz'a w�ry F�« cv,E'.�� Gvrr�� s�J c.✓iiS�.J <br />?� 7'�"��,a�`,Y c�i_'i9�i.'�/ oFF�cE' i..r' No �v.vLoc_� c�cs't� <br />/�'e Tfi�/S /,�P6'rcc�Ts��i o�.. Wi3'c.J i/f� l�ccnS�' .SS'«Ry <br />!f'e` 'T�S'''cr�_� to'cTw�n� Ti'� <br />�i:�a �i`��'/17�+.� T �SSVCifiT4i` % <br />C'E�e��en�.vc� G'u�°v%�. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant he�eby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims lor tlamages, costs, <br />expenses, or causes of action Ihat may arise because of in5tallalion <br />and maintenance of the improvement or other righFohway use hereto <br />applied for antl (urther agrees to remove same upon notice from the <br />City andT place public proPerty damaged thereby. <br />/ <br />. ;� � - <br />� �'3 -�53 <br />Sign�} re of Applica <br />WORK AU7HORIZE BY THIS PERMIT MUST BE STARTED WITHIIJ <br />180 DAYS OF DA'�E PERMIT IS ISSUED AND THEqEAF7ER IS TO <br />BE DILIGENTLY Pl�rSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY �TOPPAGE OF WORK UIJ "fHIS <br />PROJECT OVER 90 DAYS DUR�ITION. <br />�i9fiT>4G rSiyr/in'.�' �v/'c7E'� <br />hfE OW/Y�j� c..,VcG %�AST �j �SO�]O <br />Approved as Constructed � � <br />everett PUDLIC WORKS DEPAqTMENT <br />� 3200 Cedar Slreet <br />Everett, WA g8201 <br />Phone: 259�8815 <br />E. <br />� <br />l�, <br />� <br />O <br />� <br />� <br />