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h7[��1� <br />��x <br />9Hf~i� <br />i <br />�G � C) <br />H �1 <br />oxo <br />'TJ H 's! <br />V] H <br />t+7 O � <br />H t7 <br />OH <br />'� c� C7 <br />H L�] O <br />C,] � C] <br />9H� <br />� <br />r �y <br />O H <br />nb� <br />��� <br />HOc�i� <br />I��� <br />Date��'� i,�Cjl <br />qpplica�ion For <br />PUBLIC WORKS PERMIT <br />Prni or Type Only <br />� �A�ci �,� J �01 / � �i <br />�� �"� z� � nn I na Adtlress � <br />Describe Proposed Work <br />% <br />�.,�,�-�:�,�, �,,,,�,�� , <br />`�� �� / - <br />emn ow� � — <br />Pu�ucwmwsFee 5-- <br />Tolal Fcc <br />less AD��� Fee Po�d S--�- <br />o,ia�«v�� 5 �R�� — <br />�' '� �,}�.J-c'� JJ ��� L��� J <br />1 1-l�£iLL/I � <br />Z�P Phone <br />Z�p Phane <br />,�, r.� ,'%'.��� ��Ti�l:Itiip.i_ir" <br />Projecl Address 0� knownl �� ' - � <br />A��ach four l41 copies o� P�ans lor proposed work � D«w �o sca�e and note � CQo1'erline of stree� able: <br />• property Lines • Ind�cate Norlh <br />• Outline and tlimensions of all ezistin9 antl � Show any proposed grading chan9es <br />proposed slructures on Ihe lot � Show measurements <br />• Exisling and p�oposed u�iLties <br />00 NOT WRITE BELOW THIS L�NE <br />qpprovecl <br />pERM1T GONDITIONS . I <br />1. All calls lor inspection shall be made 2n hrs. in a aance � phone 259•8810. <br />2 All work shall be perlormed in accordance with hiis permil and current Ciry ot Everett Design and Construction <br />Standards and Specificalions. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800- 24� �5 • <br />�-� �e,n c e � h�- i l � `'�}Z' � b a L� n-t l� l�„�^^^'� �- {�: .v\ <br />,q �- ll.I �u.�. <br />�V J rv'�ncc, � ^ a` "' <br />1� � k e�,,2 �� s;� e,� a 1 K- -6-� <br />r �, �� 1 c_�,� ��,� ��z�-��,-, <br />5. �_� c.e, d: r�a+�s � �'� s s <br />� �' �. j� [,z.,(.t.�- �;.� 1 v�v� cC c�rz, «"�c: � <br />3��.C'"](7 �cy✓12C�3 �"1 <br />— l <br />e��2,11 a�sv �.cl�-�•�n-� -k� skc ��Z✓• 3`"i� 14',u �/;$�,✓l�lec�r3.-,•� <br />G`'�r ".�__-=5'= <br />f.�-%I� Eex-r�-f'��-'~"l�� G+�, Con s� I{ w'i��. <br />� {rw + <br />� `G�M M �� �'L 1� T� <br />f <br />5 ; ��, y ar d-3-- <br />FItdAL INSPtc i iurv <br />;,pproved as Constructed <br />� PUBLIC WORKS DEPAR7MENT <br />3200 Gedar Street <br />�'� Evere�t, WA 90207 <br />Phonc 2�9�8�10 <br />� i�`Cc,'E� � `iW � 4�r rv�n. �1�- �� ^ � <br />KNOWLED6EMENT OF CONDITIONS <br />J7 <br />ac <br />The undersi9ned owner/app�icant hereby agrees �o ho�d an� save harm� <br />less the City of Everett Irom any and all claims for dama9es. costs. <br />expenses. o� causes of action ihal may arise hecause of install;it�on <br />and maintenance ot the improvement or olher rlghl-of-way use hereto <br />Cp`�li�d� o�r ep,, cetpubl c�peoP�`�oYr� ma9ed tlherebyn notice irom the <br />��c.�= � /�'L .��.,f„�.c /< <11 � <br />� Dale <br />S� nature ol APP��an� <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED W�THIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS'ERMIT MAY BE <br />ICANC[LLED 6Y TF�E CITY UPON ANY STOPPAGE OF WORK ON 7H15 <br />PFOJECT OVER SO DAVS DURATION. <br />