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_l1@_�-�� �j ;'1. .�% S� T�,.����.-- ✓ <br /> Date I P.tii¢Wo4e Pnr _—__.__ _ —__ ' _'__ <br /> Blilq �b0� � -1�-/u-.�-� <br /> AnP�ication Fnr <br /> PUBLIC V4�ARKS PEFiMIT � "°^°°W°„"'e s _-----.. <br /> ,�,.��.P <br /> le.fALt�IfnPVaW S -- <br /> �'f^l'U <br /> Odldn-p D=e — .S �V —= <br /> Print or Type Only <br /> �� ✓1v� � //�/� � � �� � ��t� ��t/e y,�i��, ��;�- ���a <br /> ��/�r?"'-"—`�� Phane <br /> Owner Maihng AAdress Cny Zip <br /> �1. 1.r <br /> ppphcant Meiling Addres: City Zip Phonr, <br /> Describe Proposed Work ��� -- ` <br /> W <br /> pro�ectAtidress;if knownl 7���� � B9J-fL�!C 7.0 �if' � <br /> Attach lour(4)copies of plens lor proposr.tl work� Draw to scale and ncte Ihe lollowinp as appGcable: � <br /> • Property Lines • Centerline ol �treet � <br /> • Outline and dimensions of all existing and • Indiwte Na�ih <br /> proposed slruclwes on the lot • Show any proposed gratling changes <br /> • Ezistir�g and proposed ulilities • Show measurement� M <br /> W <br /> DO NOT WRITE BELOW TNIS LIAc O <br /> PERMIT CONDITIONS <br /> 1.All calls lor Inspeclion sha�l be mede 24 hrs.in advance-phone 258•8810. � <br /> 2.All work ahall be peAormed in accordanco with Ihis permit and current City ol tverett Design end Gorstruction <br /> Stendards and Specifications. <br /> 3.Cell locaHon Underground Servics 48 hrs.befoie you dig.TOLL FREE NUMBER 1•8�0•424•�5�a5. � <br /> O <br /> � <br /> � <br /> � <br /> � <br /> � ACKNOWLEDGEMENT UP CUNDIiI'JN� <br /> �i The unde�signnd owner/applicant hereby agrees tn hold ard save harm� <br /> � � less Ihe Cdy ol Everett Irom any and all claims lor daa�ages, cosis. <br /> �� evpenses, o� causes ol action Ihat may anse because ol installation <br /> L ` ., ol _}- ��l and malntenance ol Ihe �mprovement or other nght�ol-way use hereto <br /> -t�u.��. 11� k�._, I � � � applietl loi and further agrees to �emove same upon notice Irom Ihe <br /> Approved lor ConsVu lior /� Date City antl tu �eplar.e public property damaged Ihereby. <br /> � <br /> �2t�LG' S -/7- YiJ � IJ-.��I <br /> Date � <br /> FI INSP'ECTION Dale <br /> Approved as Constructed Signature u` phcan <br /> WORK AU ORIZ L'i THIS PEfiM1T MUSf BL S?ARTED WITIIIN <br /> everi9t PUBLICWORKSDEPARTMENT 1B0 DAVS OF DATE PERMIT IS ISSUED AND THERFAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Eveie�t.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHH 7N THI� <br /> Phone:259�BP10 PROJECT OVER 90 DAVS DURP.;ION. <br />