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�' ._�� �� <br />Date i(' �' <br />l� � � .' -' `� <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type On�Y <br />?;; ��JSTING _. � b� <br />,:, .-. •, <br />�-k�� ;12 v'�1 '� . , _ T. <br />Owner <br />il �1 <br />qpplicanl <br />Describe Proposed Work _ <br />Address <br />�� <br />Ciiy <br />Zip <br />�9, �y� <br />I%i�l��if. WOiAS Fi��mi� • <br />:; 1 ,-�<��j�; <br />Uiifn Dep� � - <br />______—_ _ —. <br />PuLhc WOM1x Fce <br />,o��� F�� s _ <br />tess Anp� �^e Paio $ <br />paiancc Due <br />5 r7(� O✓ <br />Prolect Addresslif knownl -ji'�` " � `�. . - <br />qUaGh �our (4) copiP.s ul plsn5 br Proposed worh � D���' �o Scale and note.�C ol,eWine al street ,�1e. <br />• Propeny Lines • Indicate North <br />• Outl�ne and dimensions ol all existing and � ghow any proposed gradin� changes <br />proposetl structures en Ihe lol � g��aw mcasuremems <br />• Ex�sdng and pr000sed ulilAics <br />'��) ;' ,�� - <br />Phone ���� "����-( <br />�) � <br />Phone <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance - phone 259•8810. ��n /�n v'Gll�� OOORH6649 <br />2. All work shall be podormed in accordance with this permit and current City of Everett Des b y nst�uuy n <br />Standards and Specificati�ns. <br />3. Call Location Underground Service 48 hrs. Uefore you dig. TOLL FREE NUMBER 1•800'�4 �Q`539 <br />�a�r �zo.00 <br />(% /�)! (,f,�.� �/� 7 �:. ��. �n �� �; 2�0.00 <br />/� L.!/:"[,��lNJ�-�'LC'ioci .f-��✓ �C/Li'✓ 6fuC�:C.c• <br />/1 ,/ L/ -�•- <br />�C'1't.l-�a-lr�d ��J 4� %YU'�CC.n,c'L� S�:-�Lt�'-r.C��l��. _/.- <br />/��Z ��i ill�tci� C)�/L�*.�t.J¢U L!G' iT1..iJ 4f�� Cfi-atniCT <br />'(/ � f <br />`fA. <br />��. <br />.� / .� s �-�.1 ��, �i� O'�l� �-��Xt � ��o�L <, . <br />,�- - - ,� � <br />5, C%�'��'-{/Lil �iC�L�CC �!� .�iC���`�PC.KN <br />y / G /j <br />-eY,�r% /I u.C�:.! L(�/l.. ( 4�4 (�C�E':.�/� Qe.1 .�� <br />,Ci �'�t�.1� � CO"n L �en.l� �tj 2 <br />�. L'(�_�Jfi� YtztJ <br />. ' .ir'u �����'�'�; <br />� t/cd Q��C <br />' � - ,f <br />. � <br />tt�tcr.t y`._,.,-, .-C�� _,w'�. <br />�J /r�, <br />�c v �; ��n' .<< zc �`'�[/� <br />Gc/ �if.C-+Cc'.��.. /Uy�� .�C�lf'i�.� <br />�� • l , • � <br />lo QfG-rrtc-(FU .Lc/vU• . . <br />...f-�d.�J.iQ�L<�'.y ff-' 11�LcLT 6l'� a��' _nr:t. <br />lc,�n/�- �x�� i��C�C�1i✓nN->� <br />/ /��r.+[-0[7� b2 R�fJ•�nr�. <br />.._ ..L `�-e � d�z ���c�a.� . <br />AC�KIJOWL7EDG ME�1T OF C�0 71 ONS <br />W <br />H <br />� <br />� <br />� <br />O <br />k'K'F'� <br />� <br />O <br />� <br />� <br />O <br />a <br />v E . i. . . <br />�� - i� ho�d and save harm� <br />7/�. y�� <br />Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Street <br />Everett, WA 99201 <br />Phone:25F-8810 <br />The undersigned owner/apPlicant hai .by ag � <br />less the Cdy ol Everelt Irom any and al' : tor damages, costs. <br />expenses, or wuses of action that may a . :cause ol installation <br />and maintenance o� Ihe improvemenl or c•.� �.�h4obway use hereto <br />applied lor and lurther agrees to remove ;� c'.iPon notice irom the <br />City an to replace public property damagt I ereby. <br />. �', ^ rJ — Z% I <br />i n. t�e ol APPIi ant Dale <br />ORK AUTf10RIZED BY THIS PERMIT MUST BE STr1RTE0 WITHIN <br />80 DAYS OF DATE PGRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PUR�UED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CiTY I.�PON ANY STOPPAGE OF WORK ON THIS <br />PHOJECT OVER 90 DAVS U�FAIION. <br />