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��y ° <br />A�1x <br />�Hx[Hi� <br />HxH <br />K C] <br />H xl <br />oxo <br />'i1 H "+tl <br />fn H <br />xo <br />H <br />OMd <br />��g <br />n� oq <br />7N3 <br />�HLx1 <br />HH <br />y <br />c� qky v� <br />�H� <br />HO[n <br />� <br />1 ��� <br />� <br />�� <br />oate�i`�� � L, ��� Un L5 I`� <br />A, plicalion h'or 11 <br />PUBLi� WO�RKS PEF� I��� Y z 3 1991 � <br />�/�., C,,I.TY OF EVERETT <br />Print or Type Only j�� ppSTIhG_ ' ��-�l�--�d�• Permit Counter <br />� <br />Owner <br />Mailing Address <br />PuolsWmxaParmlt♦ / ��/ <br />eiac. oeo�. • __, <br />Pu�i¢ Worws Fca <br />ToialFea S <br />Less Ap01. Feo Gaid $ <br />eaianae oo., s /O1'? i7 <br />S Aru �. As ALi�u� <br />Applicanl MailingAddress City Zip Phone <br />Describe Proposed Work <br />ProjectAddress�ilknown) _7Y��— <br />Attach lour (4) copies ol plans for proposetl work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ol all ezistin9 and <br />proposetl shuctures on the iot <br />• Existin9 and proposed utilities <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading chanqes <br />• Show measuremenls <br />PERMITCONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2 All work shall be pedormed in accordance with this oermit anA current City of Everett Design and Constmction <br />Standards and Specilicalicns. <br />3. Call Location Under9round Service 4B hrs. betore yoc dig. TOLL FREE NUMBER 1-500•424-5555. <br />� � -� <br />��1.'�.�i�;•;{i LUlrL.E- � .�1C Cil+�ul �.�f"2 �G-� lZ��1<`i,k�� �C/ <br />.�/4': �C,/.�c !c.'m./�s ���T`.` !'n-� 5-�2-:/ �c."sr�,0 <br />J� ,�ee �<210-..✓f �^C.-^.�zc7 .CesC�itt��i �� (�Ot.C�!eQ[�C-i,•-,ki[�tvf <br />�' �'(�c:L�,�_ ,�' �f'/�, ���--srr�� — �S'��- C��.��.-,,; I'o����a <br />- , /� -� ..n�'�ra�,� � , a /y�aa-7,<�0 2.,.�di <br />�(�'i��i C/��72L(.C'ri0' �J 6.r1C�nC!/ � / l <br />i <br />C<�.c�� /a< <�'�rt �:�j c/F�1r; ,��. 2,..�� .�7ZCCd ,-�rbJ� J _iCti.: �,-,;i ��.,;,.L��, <br />�� � , <br />� <br />Y��:.. �M' i .� .7/—�� <br />Approvetl for C osUuction Date <br />.�_, �.�� �/�� <br />FINAL INSPECTION Date <br />ApProved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />32U0 Cedar Street <br />EverClt, WA 98201 <br />Phona:259�8810 <br />ACKNOWLEDGEAIENT OF CONUIilONS <br />W <br />r <br />v <br />� <br />Z <br />O <br />♦�^ <br />�♦ <br />0 <br />a <br />The undersigned owneriapplic3nt hereby ac�rees to hold and save harm� <br />less the Ci�y ot Everett irom any and alt claims lor damac�es, cosis. <br />expenses, or causes ol action iha� may arise because of installation <br />and maiMenance ol ihe improvemenl or other riqhhohway use hereto <br />applicd lor and furiher agrees to remove same upon notice Irom the <br />City and to replace public property tlamaged ihereby. <br />5� ature of Applicant u 1 / atB e <br />' RK AUTHORIZED TH P'cRM1T MUST BE STARTED WITHIN <br />0 DAYS OF DATE PERMIT i3 ISSUED AND TH[qEAF7ER IS Tn <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY i3E <br />CP.NCELI[D BY THF CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEl7 90 DAYS DURATION. <br />