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Nli+�/.��� . . - _ <br />Date��� <br />� Application Fur <br />PUBUC �NlOniCS PERMiT <br />Print or Type Only <br />s�c <br />Owner <br />ng <br />� <br />4! ti I I co <br />Pu01ic Works Permlt • <br />81�9.Ce04 � ��j ���/ <br />Pubiic Works Fea � �).� <br />Tutal Fea <br />��� <br />Les.ApP� Fae Paitl $ -- <br />S 2A:bo <br />Belanc0 Dua <br />G �9'97 <br />,,r .,�.,-s <br />up , ,,...... <br />� /"'� <br />Describe Pruposed Work �) 2 c• } _ _ <br />Prolect Address (if known) `��"' - - - - <br />Attach Four (4) copies of plans for proposed work - Draw to scale and note <br />0 Properry Lines <br />N Oulline and dimensions of all existing and <br />nroposed struciures on the lol <br />• Existing and prqposed utilities <br />tR� following as aoplicable: <br />•� Centerline of street <br />p Indicate Nor�h <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall b? made 24 hrs. in advance - phone .^.59•8815. <br />2. All work shall be performed in accordance with this permit and cwrent City of Everalt Design and Construction <br />Standards and Specificatiuna <br />3. Call Lo:ation Underground Service 48 hrs. befora you dig. TOLL FFEE NUMBER 9•80�9•��24'S55 . <br />(� f 1 � C) � ' � •^-- <br />� f-ro.�k y a..�`,/ Se��c.cic w.u5i- b�e w..�.. <br />I �v� e.�, Q/w 1„�e Ca ��e.- ciec.�,�a.� ,�"� .,o .�lc <br />'l' O..�l' I 1 vi �f � 'i <br />/ <br />for <br />Approved as Consirucled � <br />everett PUELIC WORKS DEPARTMEN"� <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone:259-6815 <br />Shovw� o.- 51-� �lcl✓�. <br />Dat �, <br />� <br />� <br />ACI:NOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims fer damages, costs, <br />expenses, or causes of action that may arise because of installalion <br />and maintenance of the improvement or ether right-ot�way use hereto <br />applied for and furiher agrees to remove same upon notice trom the <br />City and to �eplace public pioperty damaged thereby. <br />/ `!f' =� � ��� <br />Dale <br />Signature of AFPlicanl <br />80RDAYSTOFO DATE PERMIT ISESSiJED ANDBTHEREAFTER ISHTO <br />BE DILIGENTLY PURSUFD TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />FROJEC�i OVER 90 DAYS DURATION. <br />z <br />0 <br />� <br />.� <br />c-> <br />m <br />.-. �. <br />� � <br />in= <br />0 <br />m <br />co <br />m o <br />�� <br />o� <br />-� z <br />x -i <br />m <br />.� <br />G � <br />v -+ <br />r- x <br />—I N <br />-� <br />� <br />oz <br />�a <br />-i m <br />x <br />m � <br />0 <br />N <br />o r <br />�m <br />c v� <br />: N <br />m <br />� <br />-a r <br />• m <br />n <br />z <br />---I <br />2 <br />D <br />z <br />—� <br />2 <br />� <br />Z <br />O <br />--i <br />c"> <br />m <br />