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� <br />� <br />��� <br />Y � <br />��z <br />ti°o � h°a <br />� yp � <br />H <br />� �C <br />QY � <br />�y y� <br />r�yNH <br />25y� <br />� t" <br />ea <br />a� <br />,�,_,�., <br />Dale � �� �Z <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Puohc worxa Peem�l • �� `� � / <br />e�aq oeo�� � <br />P�o��<wo��,F�a s <br />Total Fae -- <br />Llss PpP�� Fea PmE S�OC�� <br />Balancc0ue s __ <br />4n"l-S'zz�/ci��s�/ <br />q�t�i LSt-� yso <br />Zip <br />S r7M� Mailin9 Address City 2ip Phone <br />qpplicant <br />Describe Propased Nbrk � �� ��� 7 ��R� NF i��� r <br />ZI�LU (-lIFlfLA�n,yvE r��-,��i, <br />Proiect AdAress (il knownl <br />Attach lour (4) cop�es o� plans tor proposed work � Draw to scale and note the lollowing as apPlicaCle: <br />• Properry Lines • Centedine of street - <br />• Outline and dimensions ol all existing and • lodicate North � <br />proposed sirucWres on the lol • Show any proposed grading change�:. <br />• Existing and proposed utilities • Show measurements <br />� PERMIT CONDITIONS <br />t. A�I calls for inspection shall be meCe 24 hrs. in ativance - phone 259•8810. <br />2. All work shall be performed in accordance with ihis permit and current Cily of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800�424•5555. <br />� <br />I <br />/, WL��c.L�- S�R � / � !� 'Jric �.i ,r.-�,ic �i�- L*�� 2 // Gi�L � <br />( �C � Y � �",%� if'Jt-[ta� <I� /�!t/.'% l� �.uC�eN. <br />u <br />' � L�c�•.�c.-,� C� ��� % /-% ? <br />.S- P�� �����.�.� , ��,,, a <br />INII'IAL INSPECTION <br />KIRK BROOKS <br />�I��� �"' �� G �i C� � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />qppmve��� ion Date <br />�l� ��--�— a yr -5J <br />Ca'� �-�� <br />FINAL INSPECTION ��a�e <br />ApProved as Conslructed <br />�PUBLIC WORKS DEPARTMENT <br />'��3200 Gedar Street <br />Everett. WA 98201 <br />Phono:259�0810 <br />W <br />� <br />� <br />The undersigned owner/apP�icaN herrby ag�ees to hold antl save harm� <br />less the Cily of [verett Pom any and all claims for damages, cosis. <br />eapenses. or causes u action Iha� may arise because of installation <br />and maiNenance of ih9 improvement or other right�ol�way use herelo <br />applied lor and �urther ag�ees to remove same upon notice Irom Ihe <br />City and to replace p��bhc property damaged thereby. <br />�Q� � -t3-Yi <br />Si9nature of Applicant Date <br />WORK AUTIIOFIZED 8Y TNIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />