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��y� <br />O�7x <br />�Hx[~i� <br />HxN <br />�H� <br />'�Nhl <br />UJ N <br />�O� <br />OH <br />��g <br />�1] V (C� <br />�HM <br />yy <br />gd� <br />��[r=1 <br />O A� <br />U-31- Z�)-5 <br />Date��/9, TO POSTING�G�'-��5j <br />Applicalion For <br />PUBLIC WORKS PERM�T <br />Print or Type Only <br />Put�i�c 1':or�9 Pn�mil • �/ '� �,�`S_� . <br />emaoew.. �/_,�c�pctO�__ <br />/ <br />c�oi�cwo�wsrcc S <br />iotelree <br />tess AopL fee PaN $ <br />p�tnncc Dur 5 � �� � �~� <br />C C� �'-� <br />I�nl, �Yf �� l �� a/ln�irl 2. ��cP C+�o�1/ A �a #y N-„n��i-f� 9:�Zo i.�39�i�_ <br />Owner '�� Mailing AAdress City 2ip Phone <br />S@ ��n � -- <br />Applicant Mailin9AUdiess Cny Z'a05/Ob/91 7"_:ti_�r'P`IS�JORq6B;1 {"ki:_i <br />n . � / <br />Describe Propased Work <br />Prolect Atldress lil known) <br />Olb i�t-�P�E iJ2i�lC' <br />BLDG <br />FLF! CN 28.77 <br />Attach fow �41 copies ol plans tor proppsed work - Draw to scalc and note Ihe Ie'iowmp as applicable: SEWEFg�a, �-0.00 <br />• Property Lines • Centerline ol slreel �� <br />• Outline and Aimensions ol all existin9 anA • Intliwte Nonh ENDII� <br />pronosed structures on the iot • Show any proposed gradiA�i10U5B�&s'� <br />• Existing and pronosed utildies • Show measmements CST ES 5141".50 <br />......... ......"._..,.. ,,...,..,.� FwrnsF :oo.no <br />PERMITCONUITIONS CHEGK 5°�67.27 <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All vmrk sha116e peAormed in accordance with Ihis permit and current City of Everett Design and Constmction <br />Standards and Specilica�ions. <br />3. Call Location Unde�9rountl Service 48 his. belore you Aig. TOLL FREE NUMBER 1•800•424-5555. <br />� ti'V1 ��-esz-- Z--4' 9 i <br />Appwved �or Cons�ruCti� " Date <br />C>, . <br />,� : � �� - ��� ;�y_ � <br />FINAL INSP CTION y Date <br />Approved as Constructed <br />��vcreu PUBLICINORKSDEPARTPdENT <br />� 3200CetlarStreet <br />Evcrell WA �J8201 <br />��� Phone�.259-CB70 <br />ACKNOPJLGDGE:LtENT OF CONDITIONS <br />W <br />r <br />—w <br />_ / <br />�� <br />• <br />� <br />O <br />The undersigned owneVepplicdn� hcreby aq�ees to hold antl save haim- <br />less ihe CAy of Everett twm any and all claims for tlama�es. cosls. <br />expenses. or causes ol action �hat may anse hecause ol inslallation <br />and maintenance ol Ihe improvement or olher ri9ht�orway use hemta <br />appliod lor anA IurU�er ag�ees to remoue same uP��� ��otice �roin Ih<� <br />C��y anA lo replace puUlic proper�y d. ma9etl Ihereby. <br />) r <br />� �� «����� � �1 ��� <br />Si9natureolApplicant � Dale <br />\NORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COh1PLETION. THIS PEFiM1T �dAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />NROJEC� OVER DO DAVS DURATION <br />