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,✓ `- <br /> � ,�'=2SZ <br /> ��yQ VUU�¢Wo�4!Perm�l <br /> Date��_ � 'i <br /> umn o�o� • . ---� <br /> ApPlicaticn Foi _________ <br /> PUBLIC WORKS PERMIT `'"°,�W���"` s- <br /> �eseAnol fenPpia S <br /> na�a���o„� s Nv Ch19,rG,E. <br /> Print or Type Only <br /> �- ��,ers ��ee�,r�ic, ►(��oX 11-5Z �vc'rF-�G ��'_7C� oZSa--�/07 <br /> Ow er <br /> Mading�dtl�ess c�y z�n Phone <br /> ��nt -- <br /> Applicant Mailing AdAress C�ty Z�p Phone <br /> —� � ' " �e.i'� >r_ i � ��.L� � � �. � � �,� ' cti <br /> Descnbe Proposed Work a� <br /> ��b s�t c�� r i s — �,�,�_� �� 2 <br /> I <br /> W <br /> ProjectAddressGlknownl ��� � �>>�-�rY. <br /> ��_ � <br /> � <br /> Attach four(41 copies o� pinns lor proposed work� Draw �o scale antl note U�e lollowing as appli able: � <br /> � • Property Lines • Centerhne ol streel <br /> • OutLne ar.d dimensions of all existing and • Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> � EaisUng and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CGNDITIONS � <br /> 1.All calls for inspection shell be made 24 hrs.in advance�phone 259-8870. <br /> 2.All work ahall be pedormed in acwrdance with this permil and cu�rent City ol Everett Design end Construction <br /> Standerds and Specifications. � <br /> 3.Call Localion Underground Service 48 hrs.belore you dig.TULL FREE NUMBER 1•800�4Z4•5555. <br /> S! Z�o NbT OBST�UGT /�fs''•et� f�eef.fs /�.e'a�/� f�i�e�f/ , O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The under,ic�ned owneJaDP�icant hereby agrees to hold and save harr.r <br /> S !�/SCUJS��� less the Clly ol Everett Irom any and all claims for damages. costs. <br /> ��R ,9/�/�L/GNNT eznenses. or causes of action that may anse hecause ol instalV�:ion <br /> �/Ti! l�9vE �A✓is� '/ and maintenancc ol Ihe improvemenl or other right-ol-way use hereto <br /> applied for and �u�the� agrees to remove same upon notice Irom ihe <br /> Approved lor Constr ion Date City and to replace puUlic proPeity damaged Ihereby. <br /> �/t�-99 <br /> ' ) <br /> ���� �-/-�j �._ su ,-z � / cQ <br /> Date ��( ,_Cc,-�^-P- �— <br /> FINAL INSPEGTION Sig al C ol ApPhcant �a�e <br /> Approved as Constructed <br /> WOP.K U�HOf71ZtD BY THIS PEFiMIT MUST BE STARTED W�THI <br /> everett PUBLICWORKSDEP�RTMENT 180 DAYS OF DATE PERMI? IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarStreet BE DILIGENILY PUNSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evere:l.WA 9920t CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THiS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />