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�r� <br />r� <br />H <br />C N <br />THCn <br />Cxy <br />HxH <br />�H7n7 <br />oxo <br />'9 H 'i1 <br />� N <br />t+7 O � <br />OH <br />��g <br />�V Cn <br />� H [�l <br />z <br />hi y <br />g�' <br />� <br />o C v� <br />��ro <br />HOfyi� <br />� <br />I <br />�_ <br />�1 <br />, �-- <br />� --� <br />• <br />`" ,' ` ` ' �1.i''�►�t��/1-�`�'�/'� <br />Date �' �.`' ![-- C <br />qpplicalion Fer <br />PUBLIC WbRKS PERMIT <br />Prinl or Type Only <br />;� <br />owner <br />Addreso <br />r'„r.r wans rri��u � �� ���— <br />fi�!.I [lrL't • <br />i•..�i �.r wo�xs �ec 5 <br />lmai Fee <br />�,.�;F�u� «�Na,� s 3��-- <br />�.,�,�«o�� s `1— <br />e �� <br />fl" f i�:7 0 � <br />Cily Z�P <br />,� /y ��r .. 12ti J J] cd i r Y i <br />Descnbe Proposed Wo�k <br />Prolect Address pl known) <br />F, <br />All�ch four 141 copies ol plans lor proposed work � Draw to scale and no�e � CeNetline of sheel able. <br />• Property Lines • Indicate Norih <br />• OWiine and dimensions ot all e�istmq anA � Show any Fronosed graAiny cnanyes <br />praposed sinictures on Ihe lat � Show mea>wements <br />• [xisling acd proposed utiliiies <br />: ,� <br />'honc <br />Phocc <br />PEfiMITCONDIT10N5 <br />1. All calls lor inspection shall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be pedoimed in accordante wilh ihis permil and currenl City o1 Everett Desi9n and Consiruc�ion <br />Standards and Specificalions. <br />3. Call Location Untlerground ServiCe 48 hrs. 6elore you dig. TOLL FREE NUMBER 1•800•424•555�. <br />�V', �IA.K� L�MITS OF EkCi��r�'T"�c_-`�J, <br />5• Do Ncr �,eMo�e Anfti"TKa:.S, C3eusN c�� vcUcTAT�C,r� <br />�..� t'L'LM i;�C.iS i�N�i T� GF SLOPE T�"t�P i�F 51,�=PC� <br />(v . 1 tJ5 i Al1_ (� �2i�•1 �i ��C.iE 5'`f STE�'� TC �UN�/� f\V/�l�C Z <br />TU �J �'Tt�l-1 c: N S,<4 T1-1 Avt= . - <br />__ <br />��='=' <br />%. Du c�1U� �XG�av-a.T� iNTG t-��l..�- �T r3rti�c�F <br />�• I�C NUT TiZP.c�K MUi� ::ns� ST�E�=T o�. •�- s-r�,P vr�-2� <br />.�i ���- 6c issveD• <br />ACKNO\NLED6EMENT OF CONDITIONS <br />The undersi{7ned owner/applicant he�eby a9rees Io hold and save harm- <br />less Ihe Gly o� Everett from any and all claims lor damages, cosis. <br />exPenses. or causes o� actlon Ihal may anse because ol inStallaiion <br />antl mainlenance ol Ihe improvement or other nghPo��waY use herMo <br />applied lor and lunher a9r s to remove same upon notice Iwm Ine <br />Ciiy and b r f3a' publi pro Crty damagetl lM1ereby. <br />'"�h �./�� /�/�/J; <br />� <br />naNrc of Applicanl Uale <br />WORK AUTHORIZED BY ; PERAIIT h1U5T BE STARTED �vITHIN <br />180 DFlYS OF DATE PEiMIT IS ISSUED AND 7H[R[AFTER IS TO <br />BE DILIGENILY PURSUED TO COMPL[1�ON. THIS P[Pt.11T MAV E�G <br />CANC[LL[D BY THE CITV UPON ANV STOPPnG[ OF \VORK ON THIS <br />rqn IF�;T OV[R JO DAYS GU(:4T17N <br />'Rs..�._Q_��1l� � �C,zs� ( � "�T _ `.� 2= <br />;�.�,�noveA lor Construction Dale <br />��.�' _ .:a�. �3 <br />FINAL INSP[CTION Date <br />qpprovetl as Cans�ructed <br />�PUBLIC WORKS OEPARIMENT <br />3200 Cedar Street <br />P+ewt�. WA 98201 <br />Ph��nn 259�BH10 <br />W <br />� <br />� <br />� <br />Z <br />O <br />'rA <br />0�/ ♦ <br />O <br />a <br />