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�ate1_��-' � <br />Anplif,3�i0n Foi <br />PU�LIC WS7RKS PERMIT <br />Print or Type Only <br />( r �<� I �' � ir'I 'i ';�-_�:�1 � <br />Owner Mading A <br />Apphcant <br />� <br />Address <br />�imxc Wo�hs Parmil • �� � � <br />6�n9 Oept <br />� T�' � � ✓ ` <br />PuGbc YJorYs Gee <br />Toiai Fee $ <br />Le55Appl F!P Pa�d S __ <br />I(J <br />eaia��« o�� s 7?_ '-- <br />' �i:����' i �; � � ' � � ��� � <br />ZiP Phone <br />�1�,%.�r`=`:%�i �,����_�J � �'�,�.=�fir`, =.1/� �i-�; <br />Gi��; Lp Phone <br />Des�nbeProposedWork �/�—� ^i�.� - ��_. <br />Pro�ectAdCresslilknownl 320�^ �r%✓7� AvC <br />i <br />Attach four (4) cop�es of plans for proposed work - Draw to scale and note Ihe following as applicable: <br />• Property Lines <br />• Outllne and dimenslons of all exishng antl <br />proposetl slrucWres on Ihe lot <br />• Eaisting and proposed utilities <br />• Centerline of streel <br />O Intlicate North <br />• Show any pwposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. NII calls for inspeclion shall be made 24 hrs. in advanc=- phone 2$9•8810. <br />2. All work shall be pedormed in accordance with ihis permit and curreM City of Everett Design and Consirdction <br />Slandards and Specifications. <br />3. Call Localion Underground Service 48 hrs. befae you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� if,��lC�.Cti UGTZ�CI� �� SC� � u7 :S-fcCCt>c1��/ji�; � �Q..%u�.C-�<1 <br />oS-!<vx�d�„�� .�c5d' .30G 2�c.-�3 -�•� �� y o �,Z� i e <br />.s' �'.� S-�.���1��' <«�.6 �zD�,r� ,oa��� J � ,,,.�`,�' .� <br />p;Y�c.��,� � cl�.�m�r� �✓c-�um ,r <br />.�� -�nf�/OD��. /` �,� � mzAa�/c�f -�' ,� �i�rr,:: <br />Ma-�! �k.' �%1�-c!Q' �z6 --C/'� ,-0�1-�� l.r��,� <br />(1���.C'—�kittlOz� ,Cn�6/1r-Gf�.L_ <br />cf l'��� �'^c�, �..1'�lu �,�f;:��� �/..� -�,r1�� ,2C,�(cl. ,E��-;�. <br />� �"ift� a LY��,y .n-Pir.r� c<-YzSL �a�u � ��' �«/�l� �'-2�«/. <br />7 5��, c;��-z.�� ,Gx GF � <br />/�lr >v da: L�n/' ln-/1--�9�' <br />. ! '� L"C>� !!' �t: il� <br />Approvetl lor Consiruction � / Date <br />,; i <br />�� j-li�/" ���- S�� <br />FINAL IN TIGN Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar Street <br />Everett. WA 99201 <br />Phone:2,59�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />The undersigned oH��er/applicant herebvagrees to hold ani7 save ha�m- <br />less Ihe City ot Everett Irom any and all claims for can�aqes. custs. <br />expenses. or causes of actlon that may arise because oi instalta(ion <br />and maintenance ol the improvement or other n�h��of�wa� use liereto <br />applied lor and lurther agrees to remove same upon notice Irom ihc <br />Ci ❑d to replace public property damaged thereby. <br />���-n-�ti °(�,��-n-�r�.',.C, �,/ S� <br />SignaUue ofApp6cant Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS Tn <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M11.�Y BE <br />CANCELLED BV THE CITY- UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS UURATION. <br />