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,� <br />� <br />TYPE OR PRINT ONLY <br />App;icatbn Fw <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everatt, WA98207 25&BB10 <br />TO POSTING � " n � <br />�,a �/5� -\ <br />Publk Waks Permfl N � 0/� �( <br />Building Pefmtt N "J'IXo0 <br />Publb Works Fee S � <br />-�1292 <br />Appl�cant <br />Mallirg <br />Describe Proposed Work r�rr_• rrmY►u�aa�✓id O�i c^ bu� I d� <br />PROJECT ADDRESS (f known) <br />Attach four (4) coples of plans tor proposed work - Draw to scaie and note the (olbwing H applkable: <br />'Property Lines 'Outline a�d dimensions of all existing and proposed shuctures on the bt 'Existing end proposed utilities <br />�CenteAine oi street •Indicate North 'Show any proposed grading chenges 'Show measurema�h <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall ba made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this pertnit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 tirs. before you dig. TOLL FREE NUMBER 1-600-421-6666. <br />4• 4�dG �h'a' (x.r std plaN ttCool . <br />f�', t�ftoP n,n ofF mAy bc diul�Ar9ed � SPY�sti blocks o�r <br />� Gonvlec.b� oh mtcy be w�iat ta tbe on s� �G d�'z�nzge <br />systcw� <br />(p, '(3itrK�n9 <br />� <br />,f feasibLa. <br />�cs Pcr SFd �,�a�� �-33fM�*3#g <br />�r,.,,�. Wl�.e-�- G�'�/�8 <br />MPro ed f�Constfuctlon Date <br />�l,Et�.lO/�' � <br />��/ � T7� . '� ,��- �"�'ri <br />FINALINS CE TIP�ON ����' 0 <br />Approved as Constructed � <br />{� <br />,_'� ', (,;, <br />_ =(Jcn <br />!J-1' '1 <br />z-n- a_ <br />�..L�' : <br />J��/fi� <br />J�"Urv <br />�.1�.�..=�i <br />�.l'� <br />4.SG <br />�G.CO <br />1�5.':� <br />,- . <br />e7 .i°,t <br />iG. �:t'• <br />11.0'.. +� � <br />_.�•'��;, .. <br />ACKNOWLED(3EMENT,OF,�ONDRIONS-iit, ���;;i�,:- <br />n�e �naerslgned owner�ap�lkm,� ner�b�/�apkbs eo �w�d mw aave nsmbss <br />the City of Everett 1rom any and ell Galrta for damepsa, coata, s�wrosa, a <br />causes of actbn that mey erise becauae of InatetlMbn and rtWnterwroe of <br />the Mnpovement w oMer right-of-way use heieto appNed for ard NNsaprses <br />to romove same upon rwtke han the Clty and ro replace P�� �Y , <br />1Mreby. <br />. � - -9SS , <br />Slynature ot Appllrant pete <br />WORK AUTHORRED BY THIS PERMfT MUST BE STAHTED WfTHIN 180 GAYS OF DATE PEHMR IS ISSUED AND THEREAFiER IS TO BE DILI(iEMLV PURSUED TO <br />COMPLEf10N. 7HIS PERMR MAY BE CANCELLED BY THE CITY UPON ANY STOPPYIGE OF WORlC ON THIS PAOJECT OVER 90 DAYS DUMiION. <br />