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�Csl� <br />9H <br />iozx <br />C H <br />9 H C/� <br />Y xj <br />y5H <br />�C C] <br />Ox0 <br />'?1 H '�J <br />N H <br />�O� <br />H C� <br />OH <br />��g <br />�j]V (7 <br />9H� <br />t" z <br />HH <br />�� <br />C� C7 y <br />��� <br />zyti <br />HOfn <br />� <br />I' � <br />�� —= <br />!li <br />Date 2�'`l3 <br />Ap0lication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Mailing Adtlress <br />PuL��.c V:wMs Prrmit v ��/� <br />Biog Oeo� � <br />Pu�M1c Vlarke Fea <br />To�aiFep 5 <br />�essaoai Fee�•m 5 <br />�aia�er D.:e i <br />Applicanl Mailin� Atltlress Cny Zip Phone <br />Prolec� Address (if known) �� V_�21_____ � �c <br />C,ttach four (�) copies o� plans lor proposetl work � Draw to <br />• Proper�y Linos <br />• Outline and dimensions of all eMistinc� and <br />proposetl structures on Ihe lot <br />• Exislin9 and propOsed u�ili�ies <br />antl nole Ihe following ac apPhcablc. <br />• Canterline of sireet <br />• Indiw�e Norih <br />• Sho�v any propose�l9indmy changes <br />• Show measuremenis <br />IT[ BELOW <br />PERM11IT CONDITIONS <br />1. All calls for inspection snall be made 24 nrs. in ativance- pnone 259•8810. <br />2. All �vork shall be peAormed in accordance with this permit and current City of Everett Design and Constructinn <br />Standards and Specifications. <br />3. Call Location Untlarground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />���� P�' ot ��r�ved 5 k�h . d ak.ed <br />�_ ,,�-YY�_�cQi � Z( -`�3 <br />��n roved for Coi�yruchon/ Dat <br />.�C�"�Y�:1�i:'- /`�i.,l%-%� <br />fINAL INSPECTi6N Date <br />�upiovad us Cons�ructed <br />�PU9LIC WORKS DEPARTMENT <br />32COCedarSireet <br />Eve�e�I. VL1 90201 <br />Phor e:'S��HdztO <br />�—ZI-�3. <br />�CKNOVJLEOGGtdENT OP CONDIT!ONS <br />W <br />� <br />V/ <br />Z <br />� <br />The imtlersigned own�r/appl¢ant herabY �O�ees to hold and save harm� <br />less the City ol Everett Irom any antl all claims for damac�es, cosls <br />eapenses. or causes ol action thal may arise hetause ol installation <br />and maintenance ol Ihe �mPmvement or olher �ighPol-way use hereto <br />apPhed for anA lurtY^r agrees lo remove same u�on nohce from Ihe <br />Cily antl to replace puhlic pwperty dama9ed rtly. } — <br />�� a , of plican ' ` , ����' <br />WOHK AUTH RIZED BY THIS PERMIT MUST BE 5 ARTEO WITHIN <br />180 DAYS OF DATE PEflMIT IS ISSUED AND THEFEAFTER IS TO <br />BE OILIGEN7LV PUPSUED TO COMPL[TION. THIS FERMIT MAY B[ <br />Ci�NC[LLFD 6'i 1HE CITV UPON ANV S70PPAG[ OF\NORK ON THIS <br />PHOJEGi CiVGR 90 DAYS Dl1RA1'IOt� <br />