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��� <br />H <br />�tH�ti <br />Hx� <br />� � � <br />Hy <br />xo <br />O M d <br />��g <br />�. � <br />t"y� <br />N h <br />f� <br />qau <br />W � <br />O ti <br />i <br />i <br />1 <br />/ <br />�• , - <br />Date.��8 <br />Applicalion Fo� <br />PUBLIC WORKS� PERMIT <br />TO POSTING_ <br />Print or Type Only <br />��r.�� FUnt -o�? �/Sn5'q1�n'y Ff�v <br />Owner Mailmp Adtl�ess City <br />Sa nn c. <br />Applicant Mailing Address Gty <br />Describe Proposed Work <br />_ L_.. . <br />Projecl Adtlress lif known� <br />� �93 <br />I <br />Zip <br />a�ei�� v:o�ks a�,m�u �B —22 � / <br />nien ocni . � a0'/_%f— — <br />PuU�icWor�sfec $ <br />Total Fec <br />Lrxa nooi. Fec caro S�_ <br />Balance0ue S �� <br />Attach lour (4) copies of plans lor propesed work � Draw to scale and note ihc following as appli.able: <br />• Property lines • Centerline ol strec t <br />• Oml�ne and dimensions ol all existing and • Indicate Norih <br />proposed structures on the �ol • Show any pwposed graCin9 changes <br />• Eristin� and propesed utililies • Show measuraments <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspection snall he made 2J hrs. in advance- phone 259•8810. <br />2. All work shall Ge peAormed in accordance with this permit and currenl City ol Everetl Design and Constmction <br />Standards and Specilicatir,ns. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />y �sF �«Fy .9��,�.s �� �-.�,��,,�✓� <br />Approved lor <br />FINAL INSPI <br />Approved as <br />CVCfPII <br />e <br />; �,_ <br />.. "�G, _ <br />or�struC�ed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 <br />Phone 259�2810 <br />s/a r/�r8 <br />�' ���^-jL. <br />W <br />� <br />_ / <br />I•, <br />� <br />F- <br />� <br />O <br />a <br />ACKNOWLEDG��IENT OF CONDITIONS <br />The u�tlersigned owcer/apPlic:m� hereUy agrees to hold and save hann� <br />Iess Ihe City of [verelt Irom any and all claims br tlamages, costs. <br />expensn;, or causes o� acl�on that may arise because ol inslallation <br />and maintenance ol Ihe im-,�rovement or other ri9hFol�way use herelo <br />applied lor and turiher 3crees lo remove same upon notice Irom Ihe <br />City antl to replace p� ic ,.rcperty damaged fhe�eby. <br />_�%��' `--" -/3-�� <br />Signature ot Applicant Date <br />WORK AUTHORIZED B'( THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE_ PEI7MIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTI.Y PURSUED TO CO'dPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFlOJEGT OVER 90 DAVS DURATION. <br />