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J) ? /71 , _ ° ' v�ni,cv::,�w:ar��:�u= __ _—" <br /> � �r ., <br /> � � � DateS"� — e��� o��� . �1��s.���— <br /> p � � Application For <br /> y PUBLIC WORKS PERMIT '°°"""°'""`° <br /> � „ ,o���Fe� s <br /> r � � �ess nnai Fcn ra�a S <br /> KH o,,�,�c��o�� 5 _ <br /> o '� � Print or Tyoe Onlv <br /> �y N N I �^�j <br /> - N 4_�1 _ / li �-{.n �� �r�� �4n� I�(SI�1/ I�r ��� 1 �� nV�l .3�-lti-07U3 -- <br /> O� n � �" MailingAdtlress � Gity 7_ip Phone <br /> Owner <br /> � � <br /> t+ y � Appticant Mailing Address Ciry Zip Phone <br /> M <br /> y � I <br /> M /j <br /> g � r Descri6e Proposei work _j1�y������ Y R � ��YiG 1��" � — <br /> Ea ta <br /> z H m <br /> �30rA <br /> _ - � <br /> Proiect Address 1if tinown) 8 yo � ��1�1/ �)� - � <br /> Attach Uur(4)copies ol Plans�cr proposed work- Draw to sr,ale and note the lollowing as applicable: � <br /> • Property Lines • Centedine of sL•eet � �� <br /> • Outline and tlimensions ol all ezisting and • Indica�e Norih <br /> proposed strucW res on Ihe lot • Show any proposed grading changes <br /> • �[xisting and proposed ulilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> /,- -�_ PERMITCONDITIONS <br /> + 7.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. �\ <br /> I �_�� � 2.All work shall be pedormed in accordance with lhis permit and current City of Evereil Design and Construction ♦ <br /> Slandards and Specificalion5. <br /> ' � ' 3.Call Location Underground Service 48 nrs.befor•�you dig.70LL FREE NUMBER 1-800•424•5555. � <br /> ' � p <br /> �' <br /> �/ � � / �/� �c. /J � .,� /�y ' �� <br /> ��t(:LCi LC/��y r.�/'./I�L.C..G /�["l"C /�-('U ��u � <br /> � <br /> I oa�� �� � <br /> � 5�-��'/ � <br /> ���i �. <br /> . <br /> � ��I � ACKNOWLE�GEMENTOFCONDITIONS <br /> � The undersi9ned owner/npplicant hereby 2grees lo hold and save harm� <br /> � . less �he Cily of Everetl Irom any and all claims (or daina9es, cos�s. <br /> �1s' expen,es. or causes ot action thaf may arise because ol installation <br /> and maintenance ol the improvement or other righl�ot-u:•ay use herero <br /> applieA lor and Wr�her agrees �o remove same upor, noti^.e from the <br /> �. - Approved br Cons�ruclion Date City and to replace public proper�y damaged therehy. <br /> PINAL IIJSPECTION Date Date <br /> Approved as Consiructed Si9nature ol Applicant <br /> WORK AUTIiGRIZED BY THIS PERMIT MUST EE STARTED WITHIN <br /> everett PUBLIC WORKSDEPAFTIAEN7 180 DAYS OF DATE PERIdIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200(:edar S�reel BE DILIGENTLY PURSUED TO GOMPLETION.THIS PERMIT PAAV BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />