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. . . . .. . . . . r.-.+._.,��"��'°i�"�.° -. .'- - --- . -- =n�„->-�.•;�.r �r.�". . . ,.�.. � <br /> Date�L (7� Pu06c Woda Permn• _ <br /> r � <br /> Application For Biaq Deo�.• <br /> PUBLIC `NORKS PERMIT P�bLcWorMFee - <br /> ,o�.�.« s_ <br /> les�Apnl.fee PeiC = <br /> B��ance Oue s_ <br /> Print or Type qnly — <br /> �H�, ''J ✓ <br /> Qu ,-,�: � �3��- � �d�, �ds 9go �a ���--�y�� <br /> Owner MaiNng Atldress Cdy Zip Phone <br /> RrSt�aTir1l MNivA r��..J� SA�ec�r��i�s iS s38z � �I� �Jt/ �✓i �=c��-��>� �^/� c/$ 0� cJ <br /> Applicent � M ilingAddress City Zlp Phone � � 5_�,yq9 <br /> DsecriDePropoeedWork ��`� �-J�ul � � i j�'� j u_� t ,.._,r.�l 1�'� +4✓r� bcT�� ��1 <br /> �"1�..� 5 : � c �..�� (l� m-�� 7"7+.. ,/>� r h',�^�S- c u v� - /JY a r l.� � r;,�� l� l/i l'— i � <br /> !►'�✓� iT i�s ✓J- I+n ..., � , �/ �✓c Y ) lJ...c� i -//+2-r_r�v �7-•-..� <br /> �' <br /> r� ��I<. e�s T Q u T d -� �7. � �✓ � IQ N'' ,P q o., in /l� +a7 N� ti� W <br /> � � <br /> Prolect AAGroas(il known) �p,� /� �N��'"�� �✓'�1'+77. w A � .. <br /> Atl�ch four(�)copias of plens tor proposetl work- Draw tn scale and note the following as applicable: � <br /> � Property Linea • CenterOne ot sheet <br /> • Outline and dimenaions ot all existing and • indicnte North � . <br /> proposeG atructuros on the lot • Show any proposed grading changes <br /> • Eristlng and propoaed utilities • Show measuryments � <br /> � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.IUI allt for Inspsction ehall be mede 24 hr�,in advance-phone 259�8810. � <br /> 2.IUI work shall be pertormed in eccordance with this permit and wrrent City of Everett Design end Conet�uction <br /> St�rM�rtfs�nd 3pecific�tiona. <br /> 3.C�II Loatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-4245556. � <br /> �_.�%///�'-�[ .���1l.4(-�i" ' O <br /> ��..,,�.� .6�. a/,�.. v��y P�o�.�.��C� 2 �or.6.� jw <br /> �,�.� -�� ����j �,ri�.� �.� .�',�.y-d �r,�'� � � <br /> �,� . �. �, � ,��.'�-�.,.` �- �� �� �� // <br /> ��„�33' �� 22.lf� .L�-�,.��V,/' � �%�A?�f �'/�UL^Ea/ � <br /> � , r/ O <br /> /J ` ��1 i', <br /> CL��-�,lJ �G(� T •2.�'? . /i.���`�%. . <br /> (/ � / <br /> / / ��� ACKNOWLEDGEMENTOFCOhUITIONS <br /> � �%,`�� <br /> / � The undersigned ownedapplicant hereby egreeb to hold and save harm- <br /> . - - i less the City ol Everett from any and al� claims for damages, costs, <br /> '��— -��'�� ` /'� eapenses, or causes of action thet may erise becauee ol inatellatlon <br /> c- �_- � anA maintenance of the improvement or other right-of•way use hereto <br /> �� applied for and further agrees to remove same upon notice from the <br /> �_�or Construction Date City and to replace public property OamepeC thereby. <br /> r <br /> FINAI INSPECTION D:.te ����'r ���`�^^"� ' �/����! <br /> Approved as Conetructetl i nalure o1 ApPlicem Date <br /> lverett PUBLIC WORK3DEPARTMENT WORK AUTHOHIZED BY THIS PEqMIT MU3T BE STARTED WITHIN <br /> � 3200Ce0er9treet 180 DA1'S OF DATE PERMIT IS ISSUED AND TF'.EFEAFTER IS TO <br /> Everrtt,WA9820t BE DILIGENTLY PURSUED TO COMPLETION.TMIS PERMIT �AAY BE <br /> Pho�a:268-0810 CANCELLED 81'THE CITV UPON ANV�STOPPAGE OF WORK ON THI3 <br /> PROJECT OVEF 90 DAVS DURATION. <br />