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�� _ . <br /> � �w��. I(� 1 �(g � <br /> PUBLIC W4RKS PERMlT °�°- L-I <br /> PUBLIC WORKS DEPARTMENT Publb Works PertnR M �� Za7_ <br /> 3200 Cedar Street <br /> Everett,WA UB201 259-8810 e„tai��n e� <br /> TYPE OR PR1NT ONLY <C1 POSTI N G UEC J. O IAAB p�p��yyo�Fee S_ Z.d — <br /> sh�. cb . �.� �s�- �� ,,�►� �h �- �,���- <br /> Owner Mailing Address City Lp Plane <br /> ��.�IU dIC�Y��}.� � Ls�..s� U�l/Z ��`5� �l �� <br /> 3 <br /> APP <br /> Iicant MallingAddress City Zp Pfwne <br /> Describe Proposed Work Q� Q Yl � � � 1 <br /> W <br /> � <br /> � <br /> -- — � <br /> PROJECT ADDRESS(if known) 2� � �q�%h �V� SE � <br /> Attach tour(4)copies of plans tor proposed work-Drew to scale and note the following If epplMable: � <br /> •Pmperty I ines 'Outline and dimensions of all existing and proposed structures on the lot 'Existing and i',roposed WiliUss <br /> 'Centerline ot street "Indicate NoAh 5how any proposed grading chenges 'Show measuremeMs �a <br /> 7 <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1.All cails for inspection shall be made 24 hours in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with this pertnit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-6655. � <br /> �'. C'L�1� i v1�� �/'br� CGVGY�v� �'Jt�JG - 33'�f-740�- � <br /> O <br /> :o-;:s-ye e:�-rF,n a <br /> It 9H�S7 <br /> OTIiEk 20.OU <br /> �:�OTA_ 20.G0 <br /> GHE!-,'. �O.OG <br /> A C�iE�17 <br /> E <br /> q �F.`I <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �� � � �D// )�� Tha undersignen ownedapplkant hereby agrees to Mld and save hartnless <br /> , tha City ver trom eny and all cleims for damages,costs,expxise.s,or <br /> Appmved tor Construction Da e �u f action may arise 6ecause of installatbn and maintenar.ce of <br /> tha provement otherright-of-wayuseheretoappliedfaandturtl�aprees <br /> �/� t ove upon notice hom City and to replace publfc property <br /> ,��t`f'G- /d -B-SS � y <br /> FINAL INSPECTION Date <br /> Approved as Constmcted /a � <br /> Stgnat of Applkant Dat <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIhiIN 180 DAYS OF DATE PERMR IS ISSUED AND THERFAFTER IS TO BE DILKiENTLY WRSUED TO <br /> COMPLETION.THIS PEFMIT MAY BE CANCELLED BY THE CITY UPON ANY Si0°PAGE OF WORK ON ililS PRQIECT OVER 90 DAYS WRATION. <br />