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�_ _� � <br /> Date O�n2� �'� �=�,�,��<<�,�,k:.No, � �i 1� � � <br /> Applicatior}Eor ��no.oeai., �9���7 - <br /> PUBLIC WORI�S PERMIT -- <br /> Po�Le WorFs Fce S <br /> TOW Fee <br /> Q -. <br /> C� LessApO�-Fnp?ac] S <br /> Print or Type Onty x o o TO POSTING �f�°�� � �o�� 5 ��_ �_ <br /> r o0 <br /> ni ra oa <br /> w w ,�..ry/' <br /> �`� �'11,t ?� �"�J l � � � (��'S�.S/�l� ���/�B"�( ��0'�'1-� - �� �_ -'' <br /> � <br /> Owner Mailin�?M�sti ,. Gity Zip PI. � ' <br /> C� 03GJ <br /> .r O � W <br /> \ O [i; 1: <br /> � � � U <br /> �� <br /> Applicant Mailing Address City Lp pi•„ ; � <br /> Describe Proposed Work C�� <br /> Project Address(i' known) �C/�/ — •-3��/ `�f � <br /> � �: <br /> Attach lour(4) coples ol plans tor proposed work- Draw to scale and note the following as appGcable: �� I <br /> • Property I.ines • Genterline ol street C� <br /> e Omline and dimersions ol all existing and • Indicate North � �` <br /> proposed sVuctures on the lo� • Show any proposed gradiny changes <br /> • Existing and proposed utilities • Show measurements � <br /> d' <br /> DG NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-881 O. � � <br /> 2.All work shall be performed in accortlance with this permit and cu«ent 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 /> � -l�G ..��.ccK'.:i �.ycac�=�'J �d .dc'2c,� -�iL�l.., �<�-• .�."' 'JJ7:r._�.j � <br /> fu-' 4'-4'r'vrl��e.A' /"�' . �`/u'� e7/>�1•1�z�•re✓ J',?. rA: <br /> / <br /> ✓��L� -�'6'-B`� ��7''F� ..,t�4-�/u..�� . � <br /> �J�/ //�� "" �/� • V� <br /> .J� .//CL ��GPlG.rtf '�7C4C (,CQQi .�G/cX/'-� .l L_'!../+,:;. CC_Cc� .;'rS(..'L! '![ C . <br /> l �/ � �.,.c � <br /> 0 .G�LUo .�d�` -Gt��O��L�`�/ /.�G077<3frzEC'i-iey ..Qi �?L'Lc� %[/<L�Gi' <br /> J)7�2.e4Y �' 'SG:��ce�/ T/'a.T� ..f2C �La �.Gl/fE�L�t�'� �O .� � <br /> ✓ <br /> .�cECL��7�� �� -tc7�-2cr,,c�c�/�c'd�t✓�+-��-C-L'ti'�1�� �'' , � <br /> �?7-j4<-++�fQ�c.n/r'>vU��://�G"--������,�.F���.1 I'�i��[� .-C`J4�Z`Gv .�G�LC �c r�� <br /> _1'�c'7-v .ULL YUc� ��'Jf Cn� {�c�. >.:C' Qt.-a:.. .�v �t�� /�/nz �L�tr�� ., �� <br /> ` � � <br /> � <br /> ACKNOWLEDGEMENT Of CONDITIONS � <br /> The undersigned owner/applicavt hereby agrees to hold and save�rnrm-- �� <br /> less the City ol Evere�t Irom any and all claims lor damages. cosis. <br /> � expenses. or,causes of action tha� may arise because ul installa�ion <br /> �.�/,f� �,/i ��� �, and mainte ance ol Ihe improvement or other right-ohway use hereto <br /> applied f and further a es to remove same upon nolice Irom the <br /> Approved for Constructio Date Cit an o re lace <br /> y p � pr perty damaged Ihereby. <br /> � s y'o � / <br /> FINAL INSPECTION Dale � � J <br /> Approved as Gonstructed Signature ol Applicant D te <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PFRM!T MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUFD AND THEREAFTER i� TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 UAYS DUflATION. <br />