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r <br />Date�3 <br />Application Foi <br />�'�JBLIC WORKS PERMIT <br />Print or Type Only <br />oW�e� <br />Describe Proposed Work _��NS���G� �u <br />project Address Of known) <br />3o A�a <br />� Sj � Y <br />Publit WO�ks Permit • <br />BIEg. Dept y �� O <br />ruerc wo�ks Fea S%q . b U <br />iolel Fee <br />Less ApP� Fee Peltl S <br />Ba�ance Due S � ' U � <br />� <br />[ip <br />Attach four (4) copies of plans for proposed work - Draw to scale a�.� note � Ce�l�e line of str�ee� able: <br />• Property Lines • Indicate North <br />• Oulline and dimensions of all existing a�d � Show any proposed grading changes <br />proposed siructures on the lol � Show measurements <br />• Exisling and proposed utilities <br />��,�/9y <br />o y�s- � <br />PERMIT CONDITIONS <br />1. AII calls for inspection shall be made 24 hra in advance - phone 259•881 5. <br />2. All work shell be periormed in accordance with this permit and current City ot Everell Design and Construction <br />Standards and Specificationa <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />� .�� -• -�i�o �o P �,.,0.-1.: 'JJ-�1z <br />..,>>.,Il���' ��.>� ..h\t� <br />L,eN.n —a L' <br />• 1 <br />o.,. "�Pw t.- 1.�,ic�...1 . <br />\ p� f� .1-�.. <br />s � L:.� w �.... � 1- 1e e .-.� N t <br />S-iorw. clf..... lonh���o.. �..�.0 �i y w . <br />S�-..11 o�oy >_��a-i-�n` s�or.�. �:ra,.. <br />w r.�NC. \..IeJr \M J <br />c:s :�,o......, o., fe., �� e.� �Is�.. <br />� d �- 6 t � o� � i�.. l�..v s,l-..� �+i v C.. ., .- <br />�o. S r.-� rn.:. .....1 . ��� �C -�- <br />/ Ds ,•, ..o�- .rl�ow�.. ) T P�lC <br />:o...�. '�g r��,,,.,<<�. � A 1'.I . <br />(� .. \r_.i- m..•i 4- .�. � i � <br />�9 N�tJ1 C.O.�ncc�'.u.�•. � .ni.... . <br />c�'—� <br />FINAL INSPEGTION � <br />Approved as Cons}ruct <br />everett PUBLIC WORKS D <br />� 3200 Cedar Street <br />flverett, WA 98207 <br />Phone:259•8815 <br />y � ��C. CAIIUl. <br />� <br />! _ /.7- / _ 3`� <br />� Date <br />� / - �(� �'�� <br />Date <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi<aned ov.�nedapplicant hereby agrees to hoid and save harm- <br />�ess the City of Everett Irom any ano all claims for damages, costs, <br />ezpanses, or causes ol nclion tnat may arise because of installalion <br />and maiMenance cf the �mprovemenl or other rioht•ol-way use hereto <br />applied for and turtM1er zgrees to remove same upon notice fmm the <br />Ciry and to replace public property damaaed thereby. <br />�-/ � � ' �' - . <br />Date <br />Sic�nature of Applican� <br />WORK AUTHORIZED BV THI PERMIT MUST BE STARTED WITFIIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY 1�HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRGJcCT OVEIi 90 DAYS DURATION. <br />� <br />2 <br />O <br />1 <br />ti <br />c� <br />m <br />.. .. <br />�-i T <br />., .� <br />N S <br />m <br />c v <br />m � <br />O 3 <br />--I Z <br />x� <br />m <br />.o i <br />n -+ <br />r x <br />.. .-� <br />-i ln <br />< <br />oz <br />T � <br />= m <br />m N <br />o r <br />c-� m <br />� N <br />m' <br />Z l") <br />-� r <br />• m <br />a <br />P <br />� <br />x <br />a <br />z <br />� <br />S <br />N <br />z <br />-�-1 <br />n <br />m <br />