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��� <br />iO�x <br />>yv�, <br />r <br />y �H <br />�C C] <br />H xl <br />"�� N "il <br />V1 H <br />�O� <br />O H <br />�^�g <br />y, Y � <br />�H� <br />i-+ H <br />gy <br />H <br />C� C7 V� <br />��Cr+1 <br />x y �n <br />H O f/� <br />��� <br />� 1 � <br />>-�S � Q-35-Z�-� <br />Date <br />Application Por <br />PUBLIC WGRKS PERMIT <br />Prinl or Type Only <br />LC <br />Descnbe Proposed Work <br />T� PQSTING.---� -� Z <br />��- -74' � �CU1�Gl� �c;( <br />Address Cily Zip <br />Address Ci�Y Z�P <br />/1/eaJ C`'O��G�Gi <br />Prolect Address (if known) � `�"' - — — -- <br />Attach four (4) copies ol plans lor proposed wo�k - Draw to scale and note the following as apPlicable: <br />• Property Lines <br />• Oulline and dimensions ol all eaisting and <br />proposed structures on the lot <br />• Existing and proposed utiliiics <br />/ <br />PooLc wods Pmmn . � � \ 1 ` <br />Bieq ono� � %/ �?�(�.J•J.� <br />PuLM1c wnrks Fne 5 <br />TOldl Fne <br />lessRoo� FeaPaid 5 <br />Baiancc Duc $ � ! <br />• Centedine ol street <br />• Indicale North <br />• Show any proposed 9radin9 changes <br />• Show rneasuremenls <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permil and wrrent Ciry ol Everett Design and Construction <br />Standards and Specifica�ions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />'`, A�P\:cav�i shall 1oa.��.�ron+ PruP�r� l:ne. Eo Cdy4u+CPavi=o-�c..� <br />; n Q., O. \Y. <br />5, E�ros:o.� c�••irol as dt�ec.E.edb� Eh¢ ��61�C\Varkc ��iSPC.c.'te/, <br />�.�. � rl�.�.�. 3 _ �Z- �� <br />ApU�oved lor Cons clion ���e <br />C' ���y_L'r''�=' //� � - % Z <br />FINAL INSPEC710N Date <br />Approved as Consiructed <br />������� PUBLICWOfiKSDEPARTM[NT <br />� 3200CedarSlrecl <br />Everell, lNA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEM11ENi OF CONDITIONS <br />W <br />� <br />� <br />� <br />Z� <br />O <br />� <br />Y/ <br />O <br />a <br />The undersl9ned owncr/app�icant hereby a9rees to hold antl save harm- <br />less the City ot Eveiett Iwm any and all claims lor Aamages, costs. <br />eapenses, or causes ol action thaf may arise because of mstallatio�� <br />and maintenance ol Ihe improvement or other �i�h4oFway use hereto <br />appGed lo� and lurl er ngrees lo rem e me upon notice twm Ihe <br />City and lo r u public ropeity d • �hereby. <br />Si9nature ol Applicant Oatr <br />WORK AUTHORIZED BY THIS PERAUT MUST BE STARTED WRHIN <br />100 DAYS OF DATE PERh11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. TNIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVFR 90 DAYS DURAiION. <br />