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� � <br /> c�x � <br /> Q H - <br /> �HV� <br /> ��� <br /> �y � ' L I Pubhc WOrks Permil• �/_/�- <br /> � � � Date�� s,�,� o=o� . cj1, LG /76 _ <br /> o � �y Application F�� TO POSTING � �— _ , <br /> � � � PUBLIC WORKS PERMIT °°°'°w°"s�`� -- <br /> , .o����E_ s <br /> �V � Le5sAp01.FeePaia � <br /> 0� <br /> x>H BalnnceDue S aQ"� <br /> ty y Print or'ype Only <br /> H <br /> � <br /> H Q ��J �( (� p p <br /> ��'y�+ �oPr�nPffh ' LL l�� �-! y� ���-" JI���P �d /� 2j ��7�d �� � <br /> pW�e� Mailmg AdGress Ciry Zip Phone <br /> H V�i <br /> H O fn <br /> r <br /> Applicant Maihng Address Ci�y Lp Phor.e <br /> Describe ProPosed Wcrk _��=--�-W������ �� � � /�, (�� �� t �` <br /> -- w <br /> ProiectAddresslifknown) 9��Z— � Z4�^ Vr S� _ � <br /> Atlach lour 14)copies of plai .,for pmposed wo�k- Draw�o scale ar,.. .�.ole the tollowing as aFPlicable: � <br /> • Property Lnes • Centedine of strnet ♦A <br /> • Outline and oimensions of all existing and • Indicale Nonh V� <br /> '�, proposed slrucLues on the Io1 • Show any proposed gradin9 changes <br /> • Existin9 and proposed utilities • Show measuremenis /�A <br /> ' ' °� DO NOT WRITE BELOW THI� ��i:� � <br /> � � <br /> �� PERMIi CONDITIONS i� A � <br /> 1.kll calls for inspection shall be matle 2a hrs.in advance-phone 25..•..$.Q. � <br /> 2.All work shall be oerformed in accordance with this permit and�:urrent City ol Everett Design and Consimetion <br /> �ea� Standards and Specifications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBEfl'I•SOl'I•424-5555. � <br /> �� � �'i�r� .Sti��e,-�- qr� fo 6� /f¢��' �'Cea., 2f 4!! ti�n�s o� cc, O <br /> '� .:�fo�-Woi',f �Uil� 6� ��qC�c/ nr, ��� �tt6, <br /> ' (�. LtJ/'Gl J!G'7Y�r �ad Side«�,l.f �n f/x=�l�f 4rc nev✓ �»d <br /> r G�ii�4rnq�c% Unj/ o�4r�af-' �`/>c'�•f'a S/�oll �ie r'eP�ace-c/ � <br /> � qf ffiC �sti-e�•b•�, �'f/�e i�v6Lic 4Jn�,Er i���ecfo.- . � <br /> � � 7- l'/nf// G�//��Gnye in f/�z C�i�ie�-��a f/ Cu� i+��.crJ f� 4`t�ravec� O <br /> —' t�!' T� TUn��C. /NO��f //7S�OB[./(jr, ,. <br /> �5�� / a <br /> [�. ,t.e�WnS�oe�fS ?���C�/�/Qi-C✓ di'vinS S�i��C fc �is�'fl/neC� //i4. f7 {!C, <br /> �1 �i�G �D �/�� �JIi/+�i t �ai.�a�� -rf/S�r,-r, cnnSf c�tri��n . , <br /> �� 9. �'ic�r,S�<da fer B�ke1 �Z J((-e o% n f Pn�/of' - <br /> � ' c.�r,� s��LL 9e ^�i�,t�C e fe C� C I�iCd G�fuiC d�-r v�.�v <br /> _ �L� /C7, /�/^rVL /S ACKNOWLEDGEMENTOFCbNDITIONS <br /> � Oi� f/����, <br /> qi The unders�9ned owner/applicant hereby aprees to hold and save harm- <br /> Y less ihc Cit� ol Everett from any and tll claims for dama9es, cosls. <br /> ezpenses �_�•use; of action that may arise because of installation i <br /> and maiMs�ne�•.e of the improvement or other ri9ht-of�way use hereto � <br /> C-� l� � .Z.s � aVPlied fc a��urthe� agrees lo remove same uPon notice Irom the I <br /> Approve �qr Coi struction ate ���y�nd 1 ace public property damaged thereby. � <br /> � - j� i/� <br /> _( ��/���% - ��/-:��(i // ,� /r7// . i <br /> FINAL INSPECTION b�te �' <br /> Approved as Constructed ignaWre o App ic Date , <br /> WORK AUTHGRIZED BY THI� PERMIT MUST BE STARTED WITHIN , <br /> �����,�� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THENEAFTER IS TO <br /> � 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evere�t.WA 98201 CANCELLED BY THE GTY UPON ANV STOPPi'�GE OF WORK ON THIS i <br /> Phone:259�8810 pppJECT OVER 90 DAYS DURATION. � <br /> I <br /> � <br />