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J <br /> � � � <br /> H <br /> Cy H <br /> t"'yT y <br /> H�H <br /> rC f� <br /> '+tl M� / <br /> �' \,/-5-z�-S <br /> �xo� Date�5�9C! ' ` ~ Pu01¢WorFs Perm�l• ��`�3 <br /> O M t1 AnP�ication For eiae oeo�.._.�/ OZ.� �'d'.�7 <br /> ��g PUE3LI�C WORK�s PERMIT P°°���°��«•�a� — <br /> Tatel Poc S <br /> Les�Awi.Fee Pm� S <br /> z>N� <br />��� t"H � Print or Type Only B+�e�=au�� s ��— _ <br /> �yN <br /> C�C V� <br /> � 7 Z��vnr�,H�.�� �aS lSs"� �v�,�rwd� '��t/l4- 7�l5- �d'9 � <br /> ��"j Owncr '� Malling Address � CiP, Zip Phone <br /> Hc�' �n ' <br /> jM:TI �,�.��-��.31�A�a�s�su> ��� r�- 9d��� , y�-ai�a <br /> ApU�ican� Mriiling Address i�y Zip Phone <br /> Describe ProPoszd Work �1/n,(L� � L'� Lh/3��'f Z ,f3/nr� ,, �i, .`�'�d�/1_''._i'_... <br /> � ' T""" <br /> Prolect Pddresslil known) _-- I� I � 1� I��U� � AV� L <br /> Attach four 14)copies ol plans lor proposed wo�k-Draw to scale and note the following as applicabte: � <br /> • Property Lines • Centerline of street � � <br /> i Outline and dimonsions ol all existing and • Indicate North <br /> '�� proposed structures on the W' • Show any proposed gratling changes <br /> • Eristing and pwposed utililiec • Show measurements � <br /> ' ' i <br /> � DO NOT WRITE B[IOVJ THIS LINE O <br /> '�' PERMIT CCNDIilONS <br /> 1.All calls for inspection shall be m:ide 24 hrs.in advance�phone 259•8810. � <br /> 2.All wc.�k�hal�be u�dormed in�r.cordance wi�h this permit and current City of Eviareil Design anC Construction <br /> '�I StenCa,ds and Specitications. <br /> ' 1 3.Call l.ocation L'nderground Service 4B hrs.belore you diq.TOLL FREE N'JMBER 1•800•424•5555, � <br /> � <br /> '_f S . INSTALL CONCRETE CULVERT PIPfi IN DRAINA9E DITCH Ut�,DER DRZV�WAY. O <br /> 2.PAVE DItTVSW.AY EROM PROPfiRTY LINE TO EDGE OE PAVED ROAD WITH <br /> f�' ASPHALT CEMRNT. <br /> .. � r <br /> � � <br /> ( � <br /> � O <br /> ' f 1� <br /> � �� <br /> �. ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> ^—�� �.� - less the Ci�y ol Evere�t Irom any and all claims lor damages, cosis. <br /> l expenses. a wuses ol action that may arise because ol installation <br /> � � .1� - /� ��7 O� ^� and mainlenanCe o� ihe improvement or other righ4of-way use hereto <br /> `�Clt�-C �� � �y- >- '-L-- L 9�' applied �or and lurther agrees to remove same upon notice �rom ihe <br /> Approved br Consiructioi�i � Date � City and to repiace public property damaged thereby. <br /> �'f.� �� ��� '!`�> _l4 / �.fy/�� '='j_ ,� �S ' �l e <br /> F�NA�IHSPECTIGN Date " C%�i" C —' <br /> A,N+oved as Conshucted Sign�dture ot Applicant Daie <br /> evcrett PUBIIC WORKS DEPARTMEN7 �'�RK AUTHOPIZED BY THIS PERId1T MUST BE STARTEO WITHIN <br /> � 3200Ce4arStreel 180 DAYS O� DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet�,WA 98201 BE DILIGEIJTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8870 GANCELLED BY THE CITY UPON ANV iTOPPAG[OF WORfC ON THIS <br /> PROJECT OVER 90 DAYS DURA7;��id. <br /> ��----- _ _ _.. <br /> -r <br />