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C�� <br />PUBLIC WOF�KS PERMIT <br />PUBLJC WORK5 DF^4RTMENT <br />3200 Cedar SYreet <br />Evereri, WA 98201 25Q-8810 <br />TYPE OR PRINT ONLY l�%�� �.��I �� pSr <br />Y4Zs��2Z - S/�3- <br />/ <br />��a r � <br />Public Works PermR 8 _-- ���— <br />Bulkling Pertnft M <br />Publk Werks Fee S �____ <br />se� _., �l : <br />�.�_ L� r __ <br />L� <br />Applicant 1Aailing Addresa Ciry Zip Phone � <br />Describe Proposed'Nork <br />io�os q�h a�� <br />PROJECT ADDRESS ;if known) <br />Attach four l�; copias of plzns for proposed work •�raw to scale and rote iFM fa�owing if appliceble• <br />•Property Unes 'O�tline and dimensions oi ell ezisting and proposed structures on the lut •Exlsti�ig and proposed ufilitie; <br />'Centerlin� of �t��at •Indicate M;.ih 5how any propused grading changes 'Show measurements <br />PERMIT CONDITION5: <br />1. All calls for inspection s��all be made �4 hours in advance - phone 259-88i0. <br />2. All work shall be perfc., �,: ;;i accordance with this permit and current City of Evereti Dssign and <br />Construction Standaris a�id Specifications. <br />3. Call Lr�cation Unc�r�round Ser:ice 48 hrs. before you dig. TOLL FREE NUMBER 1� 800-424-5555. <br />� 0-� OQ.t.�.a��. �3SZ'�oU—U��-�DOOd <br />�, �hs�►I elbs;an cv�-lru1 zs d;rc�tcd b,� Pvblz �/�J �hs� <br />� l�,r k f� he dw�c i✓� � w+wri �.�.►- So �i da �df �.-•,Q-, c-k. <br />A�`jGrcCvt-� ��✓U�✓�f,Z1. <br />6. ,�e�� ���� s�i-cefi c%.� Et�k-�( -�'r�o, :-:_-;� ��,��;,-� <br />k G6�5� <br />�i7N_F �5.00 <br />� O?H'_ 25.GC <br />� <br />/ <br />,�� �� y/�y� <br />Ap o d or Constructi n Dat <br />, ' ��- 5-S' �9 <br />NA� INSPECTION Date <br />Approved as Constructed <br />iv9-tt�: <br />A i;i�9].59 <br />W <br />H <br />— <br />� <br />�A <br />�" <br />� <br />�s, o0 <br />. -i.Z-�:�� ?�-�.ih�i' <br />.G,:�,. <br />ACKNON'�.tDfiEMENr 0�'CONPI'f10N5 <br />The underslgned owner/applicaiit her3�y agrees�to hold and save harmlass <br />the City of Everett from any 3{.d. all claims i¢F,d.ainages, casts, expenses, or <br />causes of aclion thai may arise because of installatiq� a�[td maiMenance o�� <br />theimprovementorotherright�o(-wayysehere}p ledior.3idto`rtheragiees <br />to rtrove same �.�pon notice from th� Clty�' tc replac�a public property <br />da�aged therehy. (� <br />WORK AUTHORIZED BY THIS PE9MIT MUST BE STARTED WITHIN 180 DAYS OF D� PERMIT IS ISSUED AND THEREAFLEP IS TO BE DILIGENTLY PURSUED TO <br />COMPLFTION. THIS PFRMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJEGT OVEH 30 DAYS DURATION. <br />