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oate � �' �`'� <br />Applicetion For <br />Pt1BLIC WORKS PERMIT <br />Print or Type Only <br />Puoi¢ Worw� ve�mn • ��G' � /S <br />Ump Deo1 � ��(-`+�/-j <br />PuUIr.Worh�he a <br />Iol�l Fea <br />Leae ApO� Fee Pe�C � <br />Bsi�nce Uue i �� �• <br />�3/3 _- <br />v��'�Y� E.v .t�-e�rr/. r�l , y.'S'-iy,r�+o<<�a,/ �F.r�- f'9 � / �s1' -/�FH <br />�Owner �� Mailing Addre�s —� City Zip Phone <br />T r � .11c %�OE.cJ' /3!�y= Li!'n,e�Xs.ui✓ �•e �C��.�' t n/ _ .�5'.= - //G G <br />Applicanl Mail,ng Adcfrnss � City Zlp Phone <br />DeacrlbeProponeoWork �f/li�J S�tii�-c�f- Fo�i�.c✓ �f'L'�.f��Gn/cl <br />Y�S <br />Prolect Address lil knownl �.'G - 97= <br />At�ech lour 141 cop�es ol plans for proFosed wark � Drxw I <br />• Prooerty Llnes <br />f Ouh.ne end dii.�ensions of ell e_�.ting n�.d <br />proposed structures on the lot <br />• EMisling nnd proposed utililies <br />sc�le ond note Ihe lollowmg es epplicable. <br />• Cenlerline of streel <br />• Ind�rete Nath <br />• Shaw any proposed pradin,; chang��s <br />• Show measurements <br />L <br />PERMIT CONDITIONS <br />1. All cnlls �or inspection shnll be mede 24 hrs. in edvance � phone 259•881 5. <br />2. All work shall be pnrfo�med in accordance wi�h this permlt and cwrent City ol Everett Design and Construction <br />Slandnrds end Specilicalions. <br />3. Cull Locatlon Underground Servlce 48 hrs. betore you tliy. TOLL FREE NUMBER �•800-42�{••55bS. <br />y trilJE�kJd...� .Ar T/S L<�l� iS �.�Fs-.� A.�J C/i[.'d.�'e'/fn%. /f <br />,9.Uy s.oE.✓a�,e �.t �.e�Oe-u� �7' /i��_s'% dF .�'E.'a.aci�v eYy <br />T'pC .�iPf'eiCdti'T. T[� %✓l In��Y'Eciok:l- SA%"i[!a!!>n..�- <br />S /�.c�✓ �T,�'�U.Nt- LK' TNE Lc'�T /3� i0 bC �i'�iL�C S!- /�.S <br />/ <br />�-Z�i' j� TiHf�Ci %hti ScK;�'c+cu'Vi.Uv� L.lV�+ C�i/7N .f'di.c' _ <br />Lcld7l.0 .c'G�.v-f�FX <br />E. L�'r�••tJ Si'l�r�T.l� Fi'��iy Tirf f/a�r.tf q.cf Tt> .Bf TiC-�: <br />IiX�E'V /� %NL /-�PGiti•AC E :yCfi "t�•, . <br />W <br />� <br />� <br />� <br />O <br />'�w <br />_ I <br />AI <br />% T.�E �Te'ii t.. ,a� �.�• � �7 'r.� C� �J3 �! �.�'�u 5 T.✓•s l oT, A!� t'7" L� <br />� <br />J�CeN SNHC.�i.t/c: //dt,/ LL'T �.� !'�°.t� 4JE TMJ Dw /�'t.fT !IE <br />.�[.�'inr/JEL7. �7%' .' FisSE/»En'T :NLL�T OC 1+,cGti'ie�lU %,�/ <C%r9 /�E`Cdf <br />�`�F.c'iro i7.r �.'/L� fjF jSSVFU %M' .'c<T �'f. ACKNO'P/LEOGEMENT OF CONDITION� <br />��� "� The undersignod �wne�/appGcanl hmeby eprees to holA and ;evr� harm� <br />FINALINSPECTION `A <br />Ap�proved es Consuucled V <br />r Fl,P���� PUBLIC WOFKS DEPARTMENT <br />� � 3200 Cedar Slreel <br />. J F�A�e��. WA 9d2�, <br />� Phane:259�8A15 <br />�i(il�% . <br />Oale <br />less the Cit� o�� EvereU Irom eny and xll claim:; to� damn�es, wsls. <br />eMpenses, or cnuses ol aclion that may erisP Hecauso of Installalion <br />nnd mainlenance of the imprpvement or olhbr righhol�wny use hereto <br />applled lor and lu�ther agiees :o remove seme upon notice irom Ihe <br />City and to replace puhlic property damagnd thereby. <br />� I ,- � <br />/ ( /�.�.. �i� � �/ t��r�— / 5 � �i <br />Signn�ure of P.�plican� 6ale <br />WOfiK AUTHORIZED BV THIS PEFMIT MUST BE STARTED WITHIN <br />1d0 DAYS OF DATE PERMIT IS ISSUED AND THFREAFIER IS TO <br />BE DILIGENTLV PUf7SUED TO COMPLETION. Ti�IS PERMIT MAV BE <br />CANCELLED BY TNE CITV UPON ANV STO�PAGE OF WORK ON THiS <br />PROJECT OVER 9G UAVS DURATION. <br />