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Hn � <br /> � � <br /> m � x <br /> C H <br /> � HxCn <br /> HZH <br /> FC C] <br /> H p7 <br /> � H ��'! <br /> VJ H <br /> � z �y - ,,, -�"- �� — <br /> n ��/ � N„�,��:���o��-.��. �,.,, i -� <br /> H t7 Date_--L_'�;�. <br /> O H ma�� oeo� • — <br /> H � � Applicalion For _�___'__"_ <br /> "" " PUBLIC WORKS PE�MIT "°°"°°'°"_"` s_— <br /> H ,o���F�.� <br /> Z y �' ivss anni Fe..a:ne 5 1/��O <br /> � 7+ B�iance Dur 5 ' <br /> l� ti y Prinl or Type Only <br /> H <br /> C'] t7 V� <br /> �j � �y -r o „ SjQ�G� ICl-� tVLRET7� q87CJ� ' <br /> i M inniJ �R s�. 355- I�i,gG <br /> yp � Owner tvladmg Adtlress City Zip Pho ie <br /> qpplican� Mailing Adtlress City Zip Phone � <br /> � I .�^ / V <br /> De;cribe Proposed P1ork - <br /> � <br /> r HPro�ect Add�ess(il knownl "'�'�/`�� /���F��� l��� .5.�. <br /> Attach lour(4)copies of plans lor proposed work- Draw�o scale and note the lollowing as apPhcahle: �� <br /> • Property Lines • Centerline of street ,^ <br /> '�� • Cutline ano dimensions of all esistin9 anA • Indicate Nor�h V� <br /> proposed strucWres on the lot • Show any praposed gradin9 chanyes <br /> 1 ' • Exis�m9 and proposed u�ilities • Show measuremen�s /�/� <br /> � W <br /> DO NOT WRITE BELOW THIS LINE � <br /> Bi PERMITCONDITIONS <br /> � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design a�d Construction <br /> '�1 Standards antl Specificalions. <br /> 3.Call Localion Underground Service 48 hrs.6?lore you dig.TOLL FREE NUMBER 1•800-424-5555. �y <br /> 1�' �/. /�.�/Ji Z . . � /-'. .:�_ :� �kJ:2 (=:/��-� . L��:�i-i,_ , /'i;�.: e' . � ,� .�C�� . � <br /> ��� � �{��/ � �[C � , i� {� ,�2G ..�iG-C�c L'✓�_�� '7Lt� � <br /> ...'J � 1L`A �'.?�.a��:z� c . .l.-c:tC <br /> % <br /> � ,j� vl�c ��� .�. -..fif, ���1, ,^ <br /> " 1i� <br /> n � � � �� t . ~�5- �-� , '-.�if�' S�i�-� � <br /> �:, <br /> '-� / /_f r ,_ � - .'! .1, .. � o <br /> � � <br /> f—' e�tii4ie� i:,,�,;; ooa��ss;i; �_.... <br /> � i <br /> b000'0775 <br /> ACKNOWLED�F,.�1E,�T OF,�G(aN�11TIONS <br /> U <br /> The undersi9ned ov+ner/aPPIiEHQC�ereby�ffPe�t�hold and save harm� <br /> less lhe City o� Evere�� ��om any and alf claims for tlamages, cosis. <br /> v�� / ezpenses. or causes of action that may arise because of installation <br /> p/�3/� �- �` ,L� ��, � � antl maiNenance of the improvemem or other righPCFway use herelo <br /> / /C. /97 � `y applied lor and further a9rees �o �emove same upon notice from ihe <br /> P,pproveA �or Ccnsiruction Date Cily and to replace public pwperty dama9ed thereby. <br /> � � 7 <br /> 1 x� <br /> ��� n n�� �n �•�e � � � = ��rv� G V'c�� _ c:4-�1a-�4� <br /> i�fNAL INSPEC710N —T' Date � <br /> PpproveJ as Conslrucied <br /> Sign. ure ol pplicant ���" � <br /> WORK T ORIZED BY THI PERMIT MUST BE STARTED WITHIN <br /> evcrett PU6LICWORKSDEPARTMENT 780 DAYSIOF DATE PFRMIT IS ISSUED AND THEREAFTE�i IS TO <br /> � 3200 Cedai Street BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJEGT OV[R 90 f1�YS DUR�TION. <br />