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3 /'y �6 SEi�H �.�- �5'S <br />�BtB <br />Applicetion Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />- - S <br />8�ac Gi72r,�A¢T /Poy /o?/dYsr � �-.. <br />Owner <br />Biaa c�i9�eis'A2-f <br />Applicent <br />�'6 - /�'S� <br />Fu�Irc Woeke POrmit • � <br />BieQ Dept • <br />PULnc Worhe Feo s <br />ialsl Fee <br />laff AoO� Fee PaiU S <br />Be �nce O�e S 7cg �O <br />�v�E,�rr=.___/J� —�'i.+43ci - <br />E��,T � 9�.� y 337-9/7z <br />c�ro Zio Phone <br />;-�o a7„"'AuESf �T�%CGL 9�0�� y�i- <br />IAalling Address Cily <br />rnone <br />�/z^�,f(J <br />Describe Proposed Woik �GN�E�E�Jr O�f APM'1ox�m�v r�e y s�-�+' C4Q��' Y�/LOS <br />oF Fia� on1 A�J APP2oxim�i�"[.Y ,/3 ACiu AAbfa. Co.�sr.zucr�e� <br />..c /n � r /!J' r �?' 71.��r�.l >f tvJ lbn%O —. �_ <br />Pro�ect Addross (if knownl <br />�sr <br />� <br />A�lach four (4) Copies ol plans for proposed work - Draw to scale and note Ihe lollowing as applicable: <br />• Property Lines • Cenlerline ol street <br />• Oulline and dimensions ol all existing and • Indicnte North <br />proposed sirucluros on Ihe lot • Show eny ptopoSed grading chan�,7es <br />• Existing nnd p�oposed utililles • Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls lor Inspectlon shall be maAe 24 hrs. in advance - phone 259•881 5. <br />2. All work shell be pedormed in acco: dance with this permil and currenl Cily of �verelt Desipn and Conslruclion <br />Stendeids and Specifications. <br />3. Call Location Underground Service 48 hrs. bo�ore you dig. TOLL FHEE NUMBER 1•800•424•8555. <br />Yj �LG /IJv% /�RUfv�S �"�J %v •T(�/�/n vC i --S //�-'CCCT�iI'G�f <br />/ys: �cc.o i��,J �`�30�.,��o � o'� /ryC-r� ��'� <br />GZ �C . /F tJ�'v/'.�1'� �7 .-ScIF%-.C'i S'T�f'uC'Tu.C'C�f'� <br />5, G.e,00,.�� oF ��E �cL iS Tv BE ,r�c�/f- Su ys NnT <br />To /m�y�r �,,.� Su.¢�eovrvvi.v� LnT.s . <br />ly. .3Gb �y Of C�ETE•v �vui✓ <br />�l/, cc./, Cv�.,.ci.�,C OF T,yE <br />%" T,s i�c,��. r is <br />�y • �,rJ t/ <br />�LY/-�'�/ , <br />iS To BE P.Pc%t'EO A7 7.>'E <br />y'�,Po.�F,e ry, <br />/C7.� �iC�idG �/f� �� �7ier'LCT� <br />Approved as Construcled <br />everett PUBLIC �VORKS DEPARTMENT <br />� 3200 Ceaar Sireet <br />Everett. W/1 98201 <br />P6one: 259�8815 <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant horeby agiees to hold end save herm� <br />less Ihe City of Eeerelt Irom any and all claims lor damages, cosls, <br />ecpenses, or causos ol action Ihat mey arise beceuse ol installalion <br />and muintenance ol the improv�mont or olher riBht�ol�wey use hereto <br />applied lor and lurther a7rees to remove stme upon nollce lrom thc <br />Gity and to �eplace public property dameged Iheroby. <br />� �D �,� 3/i�/ee <br />Si�nalure ol Applicont Dete <br />WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />1�0 DAYS OF DATE PERMIT I� ISSUED AN(J THEREAFTEF IS TO <br />AE DILIGENTLV PURSUED TO COMPLE110N. THIS PERMIT MAY BE <br />CAN(,�LLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJ6CT OVER 90 DAVS DURATION. <br />