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� <br />z <br />0 <br />-i <br />., <br />� <br />m <br />�n <br />—� --1 <br />/I 2 <br />rn <br />0 <br />;n o <br />-r c <br />�m <br />-� z <br />x --� <br />� <br />oz <br />a -i <br />�y 1-- <br />� y <br />� <br />�A <br />�i D <br />-i m <br />x <br />m� <br />or <br />n m <br />C N <br />m N <br />z c'> <br />--r r <br />m <br />a <br />� <br />/ <br />;� , , <br />Date � ��'• 5 � <br />. <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� -� , <br />lCi�ill�• � <br />Describe Proposed Work <br />Prolect Address �if known) <br />.�l/�,ri�Tt���/,� �c�:z.7' <br />lr > <br />Mai4ing Address <br />Mailing Address <br />;� T-r o����:: <br />�/ i i ' <br />/s i � ^e <br />,� i;� . _ � <br />Publit Works Permil r `� �— `��U� <br />BIAB� Depl. t <br />Pu�l¢ Warkn Fee S <br />Total Feo <br />�ess Apo� Foo Pnid 5 <br />6alance0ue 5 2O �G <br />City Zip <br />City Zip <br />/ �y <br />: ��ii5l�/ /';Y //%S <br />,�S;S - ,�/s 3 l <br />.S „1:S_5 -.�,1 �1�`.S�.E. , <br />Atlach four (4) copies ol plana �or proposed work - Draw to sr.ale and note the following as applicable: <br />• Properry Lines • Centerline ot street <br />• Outline and dimensions ot all eaistiny and • Indicate North <br />proposed structures on the lot • Show any proposed c�rading changes <br />• Existing and proposed utilities • Show mcaauremerts <br />1416Y� <br />rnone <br />Nnone <br />PERMIT GONUiTlONS <br />i. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance wilh this permit and current Cily of E-verelt Design and Construclion <br />Standards and Specifications. <br />3. Call Location Undergwund Service 48 his. hefore you dig. TOLL FREE NUMBER 1•SOO•424-SSSS. <br />/, �?b5'f��3�' <br />ApProved as Conslructad <br />everett PU3LIC WORKS DEPARTMENT <br />� 3200 Cedar Slreel <br />evere�t. WA 98201 <br />Phone:259�8815 <br />o!'�� <br />� <br />Date <br />� <br />O <br />AChNOWI_EDGEMENT OF CONDiTIONS <br />The unde�sic�ned owner/applic2n� hereby agrees to hold and save harm• <br />less the City ot Evereti from any and all claim:; lor damages, costs, <br />ezpenses, or causes of adion that may arise b�.�cause oi installation <br />and maintenance o' the improvement or other riphl-oFway use hereto <br />applied for and lu:ther agrees to remeve same upon nolice irom Ihe <br />Ciry and to replace public properry damaged thereby. <br />� � <br />-'�j�`.. !� � !l'fca-:(� /�//�—_ <br />Sic�nature el Applicant i Date <br />INORK AUTHORIZED BY THIS PERMIT MUST BE °TARTED WITfiIN <br />780 DAYS OF DATE PERMIT IS ISSUED �ND THtREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COAIPLETION. THIS PEFMIT MAY BE <br />CANCeLLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 D�YS DURATION. <br />zl <br />0 <br />-i <br />.. <br />c� <br />m <br />..� <br />—� -r� <br />�-. --� <br />Vf S <br />0 <br />m <br />co <br />mo <br />-� c <br />om <br />-i z <br />x --� <br />m <br />,� z <br />n -+ <br />r x <br />1�1 1--� <br />--1 (n <br />< <br />�l <br />O A <br />TI D <br />-� m <br />x <br />m .- <br />N <br />or <br />t� m <br />cv <br />3 � <br />zn <br />-r r <br />. m <br />a <br />� <br />-� <br />