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tO 17 ,H'C <br />>Hto <br />HEX <br />H .Oro <br />to �H <br />xx y <br />[+70� <br />O HHN <br />H Of <br />0. 7 <br />C H <br />HH <br />N <br />H <br />O C7 to <br />r[ <br />ttl <br />HOrrA <br />"I, <br />1 C3 <br />7 <br />%pvecX, <br />Date LC PupOCWorkePerme• ?J ZB / <br />Application For Bldg bell] e <br />PUBLIC WORKS PERMIT NbliC <br />Fee $ <br />gegi Ap,l <br />Print or Type Only <br />TO POSiI1�G. �u-i-L.a <br />U den OH r ]� <br />Owner Mailing Address City Zip Phone <br />Applicant Mailing Address City Zip Phone <br />// <br />Describe Proposed Work -Tnsla Z-1 � r�i� inv lti'<<C U�70� i�iz ✓e- <br />LU <br />Project Address (if known) S/9�37 Se-,, 8 0 LZ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />/A <br />• Outline and dimensions of all existing and • Indicate North <br />v+ <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />u <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />Z <br />fQ,,1,�e <br />O <br />by Pt[uL GWcber , En�ineen of A-e.,C / • I <br />5 GJor� S4111 /e done uho6•- -/& sapej-ir.on <br />�r/� <br />V) <br />G'i2tl %haPccfi'on of PQuI l✓c6cr , <br />O <br />a %no <br />FINAL INSPECTION <br />Approved as Constructed <br />WORKS DEPARTMENT <br />APUBLIC <br />3200 Cedar Street <br />Everett, WA 9B201 <br />Phone: 259-8810 <br />Date <br />�� �\` � 91993 <br />ACKNOWLEDGE WENT OF CONUn.-TpIF5e�S <br />The undersigned owner/applicant hereo g�A}0 x�tl and save harm- <br />less the City of Everett from-aHYYYCCCah�l cln✓}tl�IOr damages, costs, <br />expenses, or causes of action �h�sV�rise because of installation <br />and maintenance of the improvem nt or othL- right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STXRTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />