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_� <br />��� <br />A�� <br />9Hxy <br />�C y `� <br />'� N'{1 <br />(p H <br />�'Yp <br />HC <br />��g <br />�Y � <br />9H� <br />n <br />t yH <br />g H <br />C'� C7 f� <br />� r� r <br />x y v�+ <br />H O p� <br />a/a/9z , ` <br />Date <br />qpplicatian For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />EVERETT SHIPYARD <br />GVERETT SHIPYARD <br />528 Winsl.ow Way �+1 <br />Address <br />y, .�o� `� <br />rimnc No�1s Pcrmn . <br />e�aq oco� • <br />PuO��c \Vo�b ina s <br />Toinl iee <br />lesn POG�� Fea Pa�E 5 <br />s j t Oo <br />Balanca Ouo � <br />�O? _ .33 vs� D /SB —'� I <br />Bainbridge isl, WA 98110 <br />up <br />(206) 842-9678 <br />Don Berry <br />206) 842-9678 <br />Phone <br />Des[ribc PwPoSed Work <br />Leveling of work area, consisting of lots 5-9 and part of lot 10 <br />in block "H", Mitchell LanP s Improvement Co.'s lst Addition o <br />Fverett (in SW k. �ec 21, _'�9n, RSE) <br />n� �ntl;nes on enclosed <br />Project Address 1if knowN J y�u -�����✓4y �� �� <br />Attach four 14) copies ot plans br proposed work • Draw to scale and note � Ceo1iefline ol shee� able: <br />• Pro�ier�Y Lines • Indicale Nonh <br />• Outline and dimensions ol all ezisting and � Show any proposed graAinfl changes <br />propo5ed SifUCtureS On Ihe lot �$hOw mezsurements <br />• Exis�ing and p�ePosed ulilities <br />PERMIT CONDITIONS <br />1. All calls br inspeClion Shall 6e made 24 hrs. in advanCe - phone 2b9•88i 0. <br />2, qll work shell be nedormed in accordance wilh ihis permil and current Ciry ol Everetl Design and Ccnsimction <br />� � Slandards and Specilications. <br />� � 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800�424•:i5 . <br />� / <br />'� ` /. �J24^1 ��9zt,l /N �Bil .A-�iN/ Rno.cit'^� O/ LUOL� QliGr✓ . <br />' � V !/ (/ <br />'.. .� V.n�E.�j —�`/�� FDr �9 r t�r Cc� 0�"� `. <br />f) <br />Approved <br />✓�- �Le� �y Sf����s G�C'nii 4� Q�� "tim�'S. <br />� � �. ��3, <br />on / <br />Approved as Constructed <br />PUBLIC WOF7KS DEPARTMENT <br />3200 Cetlar Slreet <br />Everelt. WA 98201 <br />Phone�259�8810 <br />tl <br />W <br />� <br />� <br />Y / <br />� <br />O <br />� <br />N <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Th^ undersi9ned owner/applicant hereby ag�ees to hold and save ha�m- <br />less the Cdy ol Everett trom any and all claims lor damac�es, costs. <br />ezper.ses. o� causes ot action lhal may arise hecause of installation <br />and mi�ntenance ol ihe impravement or other righ4ohwaY use hereto <br />applled for �nd W�Iher agrees lo remove same upon notice Irom the <br />Cily and to �eplace public proPerry damaged thereby. <br />%�.�, � � �-� 9— 3 — o9.z <br />� gnature ol Appli[ant <br />WORK AUTHORI2ED BY THIS PERMIT �tUST BE STARTED WITHIN <br />180 DAVS OF DATE PERh11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEfiM1T MAY BE <br />CANGELLED 8Y THE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />u <br />