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Amkc•tim rw Date - t --zi - % Y <br />PUBLIC WORKS PERMIT Public Works Permit --- <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street Building Permit II <br />I'll xv'r I'i. Everett, WA 00201 (425) 257-8010 <br />e <br />Publk Worke FS vo'ee — -- <br />TYPE OR PRINT ONLY <br />�p1 •}1 I` �t ) C-I ,•x �� I7A Fl"c..1+ SE ,�VeOwner i'�i lJc 9�te3 3�F7-394 <br />\ stalling Address CM Zip Plane <br />Applicant <br />Marring Address City Zip Plara <br />Describe Proposed work cru d1 _Loe/k ,¢fx. b ur aek _ M <br />Qt]— S c!"P Ot ll�u 5� --- V. <br />PROJECT ADDRESS (it known)J�0 %Vg SF <br />Attach lour 14I copies Mans for pm med work - Draw lo scale and We the following d aPPI"ble. 7 <br />ed slnKlures on "he lot • Esisung and proposed ula s" <br />• CenjPeopady Lines • et . I e end dknenv. S of a e Proposed <br />etl g � s • She"' meaeaemenls <br />• Cenlodae of elre-1 • IndrAle North • SMw arty P•aPos 9 nq an9e <br />DO NOT WRITE. BELOW THIS LINE -� <br />PERMIT CONDITIONS: O <br />1. All calls for Inspection shall be made 24 hours In advance • phone (425) 257-8810 <br />2. All work 03I1 be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. ' /� <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. V, <br />Gff� .Si1^eefs ��C++lear ;t a <br />5 ��lis O�iY✓e J /S far JO;Il accaSr COA 4�Vl •,9 P^ffoo . <br />le. Qn /PV iHUl7 6c �r�d hfOIC '�a�7 ?�, from �+2 •{iVn-i <br />LofyLine • of deriryurots/asfaT 6-T/ GuoH8en6'c4l4„JnDOo6Fieenwin0o�O!Grn l6Nl a� <br />nP <br />e e^roET3AD-- <br />-° <br />^ <br />f % AK 7oc/ <br />F <br />�/ • v ACKNOWLFDOEMENTOF CONDITIONS <br />The undersigned owrledeppllcanl Mosby e9reall to hold end nova halmless <br />.f�h�1 "na City of Everett Imm AnY aed ell claret for damages. costs. os Pensel. or <br />/J/ f •� -�D' causes Of MW tat my erase because of Installation arm mananance of the <br />no r Coinste,bon '" Improvement ar Other "Ohl OfwAY use hereto APIs,-d for arm lunher -pleas to <br />am, same upon woce horn the City and to roPlace Pubic Propa•IY asen <br />aged flweby <br />FINAL INSPECTION Date <br />APPmved es Constn Cled Signature - a <br />-- - ' — N lm n.vr .r •..T..'.......... IE De IOEPMY PURSUED TO <br />ly a UPON 4.20 7D"TXN <br />)7P <br />ugh . <br />log, r¢H._ I,.F one• et(�v✓ <br />�Ml lit ue nc/S ..Sly ncSG <br />-7i;4 P' <br />M054 � <br />UW��erS �. <br />I /�(/KN <br />