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� � � ' . � ��y1_- <br /> b � ,.,,,� �w�.,�,��,.,m,. �. <br /> � Date �� ' ��' <br /> p [u�u� oc�i • _ <br /> y Appl�Cation For <br /> � � �n PUBLIC WORKS PERMIT "°°'°w°,".`°" s -- - <br /> ,�,r��.. <br /> O P! O �ns��ooi r.n a.,e S—_—ZT-- <br /> � N � PaiancnDue S 7��( ___ <br /> � � � Print or Type Only <br /> �i QoQ � 1.,�/c S f o r- t/d' �i /Y�? ��� L- v a.-f Jj �J'Z J 3 ..Z.T'.7 3�}' � 9 <br /> � • �] MndingAtld�e§s ..•�. � Phone <br /> � Owner <br /> H � <br /> y y �p���� Malling Address Cdy Zip Phone <br /> a <br /> � � DascribeProPosedWork QY �A � 4 � � /� � �� /Nf�a /l rr'�n nl /� � // <br /> _� � /n � � /1 R n`���� L C2 /� !i <br /> W <br /> Proiecl AA�resslil knownl ������������ � <br /> Attach tow 14)copies o�plans lor proposed wo�h� Draw to scale and note Ihe lollowing as apV�icahle- � <br /> • P�cperly Linna •Cenledine ol slreel � <br /> •Pulline and dimensions of oll ez�sling antl • Indicale No�th <br /> pruposed siruclures on the lot • Show any proposed grading changes <br /> • °xiSlinq a�d pfOp05ed u�ilitie5 • Show meaSUrements � <br /> ` DO NOT WRITE BELOW THIS LINE O <br /> (��� PERMIT CONDITIONS � <br /> 1,All calls lor Inspeclion shell be made 24 hrs.in advance-phone 259•B8�0. <br /> • � . 2.All work shell be pedormed In accordenca witn Ihis permit and current Gily of Everett Design and Constructlon <br /> Standerds and Specillcallona. <br /> �— 3.Cell Location Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. �� <br /> J • � <br /> , `� l<.;-z�: �, L�< <�� ��� _ ,� tT.-�i:,,J' /!/�„ „,r..-/ �-% -i=, � <br /> � ��' J .'fi�lit�- t,� .�u �a �<.�!'/��.,,i, G�C'� f�„An ��/ � 3c.'1� �l'of�« �it�fno%„/� �� <br /> .+ <br /> � ', � ��/ �a,r.e<<,� ,L'jf...l�/� �t m„�.>c,a�2.����L���seof'�� A�c��. �� <br /> � ��� . 7. ,�',i/�.vti/.<�<>-._ n�'.i�A..; ��r,E7pii5/ ��,� �� rn��c��.��i�t��f�,... .�, ���uc'! . <br /> � <br /> l*-��N �� � .6�•7- ��<+�� N'l.�l �Zlqe(a��:, 4 �Jri .�rl�� ��, /�i..1.4�rr Q���«:]�.r,. r� � <br /> 1 r <<�.qiV �'Niw�. ��tni�l-�ir�L�n�� !',� rC S�(4i�alVr�f/ nlri� �1��<t��� n. <br /> .�1.6`L I tt <br /> �� ' � .�n�'� „ lf �h� t�J-�� lt�����ra�� c/.pt°). <br /> h.<ic�;� P f (r� ,<< <br /> IIACKNOWLEDGEMENT OF CONDITIONS <br /> ��1� The undersigned owner/applican�hereby aB�oes to hold and save h�im� <br /> less Ine GIy ol Everett Irom any end a�l claims for damHges, cosls. <br /> � eapenses. o� causes o� aclion ihat may aris'e because of inslallation <br /> � `�L' _ T/��-�� � and mainlenance ol Ihe Improvement or other rig�Po4way use herelo <br /> l/ ! ��-"* // '� �1 apphed for and lurlhm agrees to remove same upon nofre trom the <br /> � Appmvod f Constr ro�� ��O Cdy and�o replace pubhc properry dama9ed Ihereby. <br /> G� � •ea /, � 7 � 1-� ' i rY c2� ✓ / r1�1�, U ��7e� <br /> FINAL INSPECTION Datc ��--� Date <br /> Approved as Constiucted Sipnalure ol Applicant <br /> WORK AUIHORI7F.D BV iH15 PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> J100Cedai Street BE DILIGENTLV PURSUED i0 C:.MPLEiION. THIS PERMIT MAV BE <br /> Evarell,WA 98201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORH ON THIS <br /> . Phone:25J�8B10 PROJECT OVER 90 DAVS DUHAiION. <br />