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D8t8 '�C V 1 <br />App!icatinn For <br />PUBLIC WI�RKS PERMIT <br />Print or Type Only TO POSTING I-_____ �� <br />�l� v�1,c/�1c /Yr✓Ki- a[J�� IQS2d9 1�/ SII <br />AppGcent <br />Madmg Address <br />P66 <br />c�iv <br />paecribe Proposed Work �i • �� � � <br />Prolact Addreae lil hnownl <br />� <br />Altach lour 1�) copiea of plens lor propoyad work • Orew lo scale antl note Ihe lollowing es appliceble�. <br />• Property �fnes <br />• Outline end dimeneions ot ell eriating entl <br />proposetl atrucluree on the lot <br />• Exieting and propoeed utlllties <br />Pupl�t W0.4� Vwr • �M.� <br />dnp Oen1 . _ _' _ L <br />Penim. Wa�M ire <br />�o„� �.. s _— -- <br />lefn �npl fne Pud f - <br />1� <br />e.�.�,:, n�. i ��— _ <br />• Cente�line ol elreet <br />• Indicale North <br />• Show eny p�opoaed grading c�anpns <br />• Show meesurements <br />PERMIT CONDITIONS <br />1. Ali celle for Inapectlon ehell be mede 24 hra. in advence - phone 269•861 O. <br />2. All M ��k ehell be pe�lo�med in accordence wlth thia permit end curtenl City ol Everett DeslB�i and Conetructlon <br />Slen�.erde and Speclllcetions. <br />3. CeJ Locetlon Underpround Service 48 hre. belore you dig. TOLL FREE NUMBER 1•800�424-566li. <br />� G��,� cvr c��rs7��� dFz7 o�a2 s�n►��,�r-' <br />l�" SR�JcK �� i�/rc,� A r- i%7�✓c e�trl u �v�' <br />GrT�� �� El-f?zc-7T 5�-U �"l��'q <br />� .7 � /%�� /�- /� "�2 <br />Approve r Construction Date <br />� / �• , <br />� <br />L INSPECTI ate <br />Approved ea Constructed <br />everett PUBUC WOPKS DEPARTMENT <br />� 3200 Ceder Slraet <br />Eva�et�, WA 99201 <br />Phone�.258•8910 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The underslyned owneUepplicnnt hereUy agrees lo holtl end seve he�m- <br />less the Cdy ol Everett from eny and aq claims br pemugos. costa. <br />expenses. or ceuses ol nctlon Ihel may ense bscause ol inslalletion <br />end mamtenance ol Ihe improvement or olher rlghl�ol�way use herelo <br />epplied lor end lurlher egrees to �emove same upon notice Irom �he <br />City end to replacx hc proper y aged therebv. <br />i�- � � ,�y <br />S nalure oi A pl anl Date <br />\VORK AUiHORI ED BV THIS PERMIT MUST BE STARTED WIIHIN <br />180 DAVS OF D TE PEFMIi IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEH 90 DAYS DURA1iON <br />