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=��� <br />a <br />��� <br />� <br />R�� <br />^y��� <br />1"1 l'i <br />4� <br />�yM <br />W <br />�� <br />O� <br />�;. �,� <br />� . <br />� ?i-z9^S <br />Date�� I <br />qpplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only TO POSTING �lii -�� <br />� �i��y�/ r'�u <br />owner <br />Mailing <br />. Describe Proposed Work <br />! <br />c�r z�n <br />9i ao J <br />vuei,c woiMa Prypi t • <br />L <br />Bl�q DeO��' � — <br />P��iic Wods Feo s <br />Tot�� Fee <br />Lefa �Ga� Fee PaiU S //y� <br />9elanca Due S J •�� 72 _. <br />Project Address �if known) J 2� S— // /c %�avy�_CL .�✓e <br />V <br />Atlach lour 14) copies of plans for pwposed work - Draw to scale antl no�e � Cen�e�ine of �Pee� �ble: <br />• Property Lines • Indicale Norlh <br />• Outlme and dimensions of all existing and � Show any proposed grading changes <br />proposed struclures on the lot � Show measurements <br />• Existing and proposed ulilitie� <br />PERMIT CONDITIONS <br />1. All cells lor Inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed In accordxnce wilh this permit and current City ot [verett Design and Consiruction <br />Ste�derds and Specfficatians. <br />�. Call Location Underground Service 4B hrs. betore you dig. TOLL FREE NUMBER 1•500-424-5555. <br />� �u ¢ � � <br />� d_- ��- /- ��.z�:r- < < „�l� ��c-� <br />� � � 4_ �' %l"Il 'li <br />�J,/�q _t� �'.�r/ ��t.l.�« <<;�->��- <br />�O_GG,r,� rz���en `: <br />2����f:' on� 7 —2-!/ l <br />� <br />,� <br />'���r--r�- 7/s�i/ <br />Appioved lor C nstru t' n Date <br />�//L� /v ..13-9/ <br />FINAL Ifd PECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMf NT <br />� 3200 Cedar E"eel <br />Everett, WA 9820 i <br />Phone:259�8810 <br />W <br />� <br />� <br />� <br />O^ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/appliwnt hereUy ac�rees to hold and save harm� <br />less Ihe City ol Everett irom any and all claims lor damages, cosls, <br />enpenses, or causes ol aciion ihat may arise Uecause of installation <br />and maintenance ol Ihe imUwvemenl or other n9h4ol�way use heieto <br />applieA br and Iwther ac�rees tu remove same upon notice Irom Ihe <br />City and to replace public properry� damaged Ihereby. <br />— \ �-;y•�I <br />� � �� oa�� <br />Signalure ol Applic 1 <br />WORK AUTHURIZE BY THIS PERMIT MUST BE STARTED WITHIN <br />180 Dl.YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TNIS PERMIT MAY BE <br />CANCELLEO 8Y THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEC? OVER 90 DAYS DURATION. <br />� <br />