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Date ��3 85 <br />Application For <br />PUBLIC WORKS PERMIT <br />Ptint or Type Only <br />; CA.CtSo.�/ �9/B- 5/+�yN,E. <br />E <br />B.s- z�/ <br />weiK won�. v�rmn • <br />aM0.o•otr�//S� /�' <br />waK wona F.. s <br />To1N FM <br />L��� MDL F�e P�IA f _ <br />B�Nnc� Du� <br />�S9— <br />Si�/�%E Z�p pnone <br />ApP���� Meiling Address Ciry <br />Describe Proposed Work <br />Co.v.fr•rv�r `�- f'cEX <br />Prof�t Addross �1t knownl `�52� '4 � C �� OA�CES <br />Attech four (4) copies of Dlens lor Droposed work • Draw to scale a�d note the fc.!nwing as eppllceble: <br />• PropeRy Linea <br />• Outllne end dimensions of ell existing and <br />proposed atructurea on the lot <br />• Exlating and propoaed utilities <br />• Centerline ol streel <br />� Indicete North <br />• Show any proposed Brading changes <br />� Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspactlon shell be rtiade 24 hrs in advance • phone 259-881 5. <br />2. All work ahell he peAormad in accordence with Ihis permit and current City ot Everett Design and Construction <br />Standerds and Speciilcationa <br />3. Cell Location Underground Service 48 hra beloie you dig. TOLL FHEE NUMBER 1•800•424^5555. <br />f! T BF �'o�uS�',�'vcT�o P�� A�.�.rop�0 <br />P«,�s vA>Eo 8 iz-8s <br />Approvad for Constructio ' Date <br />` �%��%�O� /-d�-d� <br />FltfAl INSPECTION Dale <br />Approved as Conshucted <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Street <br />Everet6 W.4 98201 <br />Phone: 259-8815 <br />ACKNOWIEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned owner/appticant hereby agreea to hold and save harm• <br />less ihe City ot Everett from eny and all claims for damapea costn, <br />expense& or causes ot aciion thet mey arise because ot installation <br />and maintenance of the improvement or other right•of•way use herclo <br />applied for and further aBrees to remove same �pon notice Irom the <br />City and to replace public property damaqed thereby. <br />,�--..n `�i,r„_�.��_ <br />Siqnature ol Applicent Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEC AND THEREAFTEFi IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />P50JECT OVER 90 DAYS DURATION. <br />a <br />z <br />0 <br />-i <br />c� <br />m <br />�� <br />�.y J <br />N 2 <br />0 <br />m <br />�o <br />mo <br />-i c <br />om <br />_ .�-� <br />m <br />Q z <br />a -+ <br />r��.. <br />1 � <br />s <br />� <br />o� <br />�a <br />--i m <br />x <br />m .� <br />N <br />�m <br />r3*S N <br />� <br />z c� <br />-i r <br />• m <br />a <br />� <br />-�, <br />� <br />� <br />V <br />C <br />�--1 <br />� <br />m <br />