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��y� <br />O �1 5 <br />9HN <br />r <br />H H <br />�H� <br />� V1H <br />�x <br />��i <br />H/��8 <br />y� V CC] <br />9 H C+7 <br />� <br />t yH <br />g H <br />C� C7 f/� <br />��ti7 <br />zHW <br />HOcn <br />DateJ/1Q�4I <br />ApplicationFor TO POSTINI <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />(� n -�/� JI� 1 <br />N ri ' Z �<411 ��� /'1in aZ �n (�1/ /��r^ ��4 <br />Own�r Mai!ing Atldress Cily <br />Applicanl <br />Descrihe Proposed Work <br />I_f�f�[�FF9 <br />Proied Address (il known) ��'yin _ S_ /s': <br />PuOi�c Wm�.s Pe�md � � ��, l% <br />aiag Oept. �a�1�qQiJ , <br />Poeim wo,xa Fee — <br />ro�a�.�o s <br />�eunnoi vicevam S <br />o.,ia���o�a 5 Jc �', <br />Z'P Phone <br />Zip <br />Attach lour (4) copies ol pians for proposed work - Draw to scale antl note Ihe lollowmg as applicahle: <br />• Properly Lines • Centerline of street <br />• Outline and tlimensions ol all existing antl • Indicale Norih <br />proposed structures on ihe lot • Show any proposetl grading changes <br />• Existing and proposed utilities • Show measuremems <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be matle 24 hrs. in advance � phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit ond current City of Everett Desi9n antl Constmction <br />Slantlartls and Saecilications. <br />3. Call Location Under9round Service 48 hrs. bebre you dig. TOLL FREE NUMBER 1•800•424•5555. <br />y<<�-��.�� �� �-��_�.�.� ��>���,.� �,��li.. <br />�/�:� 7-23 -i/. <br />� ,�.� <br />!- -, - - <br />�. C,./�t�.«-:; �. � fy��,�.�r�. �z., P600— �-,;-�n.',�,« „� � � <br />., j �c�„ �-Z,�. <br />�c� ._Sl'�,�,: f �r.,�/ lt�Ct� _lr/�;�r�,�.,� ` <br />.�,; ,.f> <br />���.'t`",`'_ %/ ��%� <br />�pP�oved for Conslruc� n ate <br />� , / � <br />��'�vra' ,;2 /�'-5 L <br />FINAL INSPECTION Date <br />Approved as Con,lructetl <br />�Ft1�UC WORKS DEPARTMENT <br />�� 3200 Cedar Slteet <br />Everett, WA �JO?Oi <br />Phone'259-G�10 <br />W <br />� <br />�w <br />_ / <br />�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unde 7netl owner/applican� hereby agrees to hold anA save harm- <br />Iess Ihe � y of Everetl Irom any antl all claims lor damages, costs. <br />Cxpenses • causes ol action Ihat may arise because of inslallation <br />and mainic �nce ol ihe improvement or other righ4ol�way use herelo <br />applietl lot ,d furiher agrees to remove same upon noticc Irom �hc <br />City antl t0 replaCe publiC OrOperty damaged ihereUy. <br />Signalure ol Applicam Date <br />WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS 70 <br />BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAV BE <br />GANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJGCT OVER 90 D�YS �UR�110N. <br />