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y�/� !/� PuUbc Worb Permil r �.V , /" � <br /> Date�. fl <br /> � Bldp Deo� �— <br /> ApDlicn�ion For O�— <br /> P�R M IT Pub��c Worxa Fee � d'J <br /> PUBLIC WORKS Toulfee <br /> Leu�Ool.f ee Pe�] S�---�—' <br /> B�brca Due S �7 C� '�� <br /> Print or Type Only <br /> �,.,�.-.�� WN-+�b'W'� �YL 27Z2 GCJJ�h�fl�l �1f841� �'�'��Ph—�L� <br /> r Zo <br /> Owner Mailing Adtlress �� __„ <br /> ��'�J 2�1 '`1 l`1_1 — <br /> .�� oj�ic�b <br /> 1, s�n� (,0+�1" c_cc� � ta[� . Yrr�� Phonc <br /> AppliGaM Mai�ing naor <br /> City Z�p <br /> �7 ''�G�HI� <br /> Doscribe Proposed Work ��i�� <br /> � - W <br /> Project Address(il known) ��J�O � C � <br /> � <br /> Altach four(4)copies d plans for proposed work• Draw to scale and note�Ceo1�edine of stree(able: � <br /> • Proper�y Lines • Indlwte Noilh <br /> • Outline and dimensions ol all existing and � Show any p�oposed grading changes <br /> proposed siructures on Ihe lol � Show measurements M <br /> • Existing and proposed ulilities W <br /> DO NOT WRITE BELOW T:iIS LINE O <br /> PERMIT CONDITIONS ^ <br /> t. All calls for inspeU�on shall bu made 24 hrs. in advance� phone 259•881 5. <br /> 2. All work shall be pertormed in accordance with Ihis permit and curreot Gity ot Eve�ett Design and Consirudlon � <br /> Standards and Specification�. � � <br /> 3. Call Locntion Underground Servicc 48 hrs.betore you dig.TOLL FREE NUMBcR 1•800•424•55�� � <br /> p � J��-yt c_ ,j' O � <br /> /f %�` W i D r /✓�rI x��il — /N <br /> �-;� .�c��' I♦-A- � �_ <br /> ��/� V f � � <br /> � c,- ��/T�v�,��G `� r <br /> /�/'p/� 7� /_/ O ° <br /> �7 �-o f�/�//�iaT� �,}i'!�''�"`�..t T �5 �. <br /> ��(L�s.,�co �.rF a � � <br /> -�.f--7C p,�J /'� �C��C'P� �vG � y � <br /> � cl/.�c/�"c=h/�— �� sTi9,G�,.s'. � ` <br /> �I,�,�,L�i�� C���- �� , /� � � <br /> -� S'i7i'�c,S <br /> ��/�_ �O��r//��� AGKNOWLEDGEMENT OF COVDITIONS <br /> / .,fi <br /> The undersigned owner/applicant hereby ag�ees�o hold and save harm� H F. <br /> less lhe City of Everett Irom any and all Gaims �or tlarnages, cosls. H c <br /> � /' eapenses, or causes ol aclion that may arise beca�ze of installation <br /> L <br /> and maintenance ol the i rovemen� o� o�her right-ohwap use here�� r c <br /> __C��i �� / aPPI� for antl 1 her . rees emove same uPon no:i:e from the � ,- <br /> G� Dale ;ily nd o repla publi erty aged lhere6y. r, <br /> Ap d 1or Construction ' <br /> � -, / `{ <br /> f-�7 �l-- , -� r-�y � -��____ �; : <br /> Date � � <br /> F�NAL INSPECTION D�te � - <br /> Signature of�ppliwnl <br /> Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN � <br /> I everett PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED APiD THERE�FTER IS 1G , <br /> I ,7200 Cedar Str^et 8E DILIGENTLV PURSLED TO CON,PLETION. THIS PERMIT h1AV BE <br /> � [veretl WA 9d2G1 CANCELLED BY 1���CITY UPON AN'` S10PPAGE OF WORK ON THIS <br /> . I,cn� 'S9�9515 pgOJECT OVE� '�i� �A1'S DUF7ATInN <br />