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-1 <br /> � <br /> ►' <br /> -r �- r -- .�w;,;. �+-�� �,a���� �;��.. �` <br /> �,��:,::.�. .��uc,�w� , <br /> ,��;. <br /> !/� r�� . , Pubh[WoiNa Permq.� .� . <br /> Date�r�- eiaa o�w.. '"�r- / / y <br /> � Application For � <br /> PUBLIG' WORKS PERMIT PubTotalFeeFoe $ <br /> Less ApO��Fee Paitl 5 <br /> Balanta0ue $ <br /> Print or Type Only � ,,� <br /> � <br /> I /�� c`'<�. �"o � , <br /> � � _ `� �--��r-r---z�—�—� ' <br /> �,�--C � , •. � /� -.�— v—��;'_r`_ � � — / ( ;', �%�, .� �. ., (,%/.�t'� _ <br /> - ��Er MailinyAddress �/ CitY �� Zip Phon'e. . .;�;+,�.1 z <br /> ,�( •�: �. �-. o <br /> -� <br /> .. <br /> n <br /> . rr +-+ �i — �,',� <br /> APP���;�� Mailing�lddress City Zip Phone <br /> � . �� - � <br /> .. .. <br /> � , c.� 4�. . --I '*7 <br /> Descr;oe Proposed Work �'- • � � � ' — . <br /> r. � <br /> i� N = <br /> ' m <br /> 0 <br /> -- c o <br /> mo <br /> W � <br /> O 3 <br /> m <br /> ') �(� r / ' cr / /, �c�. '-�r- -Zi <br /> Prolect Address(il known) / �� m <br /> Attach tour(4)copies cf plans for proposed work- Draw to scare and note the lollowing as applicable: � .o z <br /> • Cei.terlinc ol streel � � <br /> • Properry Lines � _ <br /> • Outline and dimensions of all existing and • Indicate No:ih ,.., ,.,, <br /> proposed structures on the lot • Show any proposed gradiny changes � v� <br /> • Existing and proposed utilities • Show measuremenls M �t <br /> W � a <br /> DO NOT WRITE BELOW THIS LINE O = m <br /> PERMIT CONDITIONS m � <br /> � <br /> � 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � � <br /> 2. All work shall be performed in accordaoce wilh ihis permit and current Cily oi Everett Design an d Constructlon � m <br /> Standards and Specifications. 3 �Ni+ <br /> 3. Call Location Underground Service 48 hrs.belore vou dig.TOLL FREE NUMBER 1•800-424•5555. � Z � <br /> -�m <br /> � — O � <br /> /J ��,�% %/ /Lr�i ,��-�,�'_.i; �=-v � <br /> _ <br /> � � A <br /> / �i 2 <br /> � �/�/ � M <br /> N <br /> O Z <br /> O <br /> � <br /> .. <br /> � n <br /> m <br /> � ACKNOWLEQGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ac�rees to hold and save harm- <br /> less ihe Cily of Evereq irom any and a�l claims for damages, costs, <br /> ezpenses, or causes of action thal may arise because ol installation <br /> and maintenance ol the improvement or olher right-obway use hereto <br /> applied tor and further a�rees to remove same upon nolice irom Ihe <br /> Approved for Construction Oate �i�y antl to replace pu6lic property damaged thereby. <br /> FInIAL INSPECTION Date Date <br /> Aporoved as Conslrucled Signature ol Applicant <br /> / WORK AUTHOR�ZED BY TFiIS PERMIT MUST BE STARTED WITHIN <br /> . �everett PUBLiC WORKS DEPARTMENT 180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Strezt BE DILIuENTLY PURSUED TO COPAPLETION. THIS PERMIT MAY BE <br /> f_verett,WA 98201 CANCELLED BY THE CITY UPO"I ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 00 DAYS DURATION. <br />