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� ^1I'� � � � :► /� {� <br /> �'d(@'� '1� i , W � `-' � � Po�I¢WorFe Permi�i _ r1 �' � / � <br /> Applicalion For � (� �i�8f'� Bieq Oeo��• <br /> (� :. <br /> PUBLIC WORKS PERMIT .,.........' ..P°°��°W°,�.°°° <br /> ..:...... ..... . ; Tolel Fee s — <br /> ................ .... f EVERETT <br /> CITY 0 �e�e Apo�fee P�id s <br /> Print or Type Only pi�t;ie Works Deo,. e,,.��.o�e s� <br /> s3 83 � <br /> ��6G`I �EE F�ENT �E 4'134 �Ay l'I Ec� �N ,�vE,ecr r , �v �9 3�i3 -�7�-f� <br /> Owner Mailing Address City Zip Phone <br /> sA m� Z <br /> AOP�Icant Meiling 4dd�ess City Zip Phone � <br /> �-I <br /> CII �/1 ,\ [�� r Y �� ' EAS�m�n�7 m <br /> Describe Proposed Work u T ��'�W/� �L�C2S C/V �� <br /> So �veClin �HA�r��c. ,eunn �n �� wATE2 7�'o C�n> TE2 <br /> � <br /> r�� ��2 l0 I •f"v2 7��Ai/)�c� � <br /> — =, „ <br /> � � <br /> v+ x <br /> Pro}ecl Add�eae(il krown) �T��C' �✓ � f � I�-w F- ^� �V���7 T u/ � . � m o <br /> � oc; <br /> AtteCh lou�(4)copies ol plans fnr proposed work•Uraw to scale and note the following as applicable: � � _ <br /> • Property Llnes • Cenlerline ol streel � _ � <br /> • 7utlina end dimeneions of all ezisting and • Indicate North m ,.., <br /> proposed siruc��ree on fhe lol • Show any proposed prading chanyes '� _ <br /> c <br /> • Exieting end proposad utilities • Show measurertients � � _ <br /> DO NOT WRITE BELOW THIS LINE � � <br /> O � <br /> PERMIT CONDITIONS �7° <br /> 1. All calls lor Inepect!on shall ba made 24 hra in advance-phone 259•881 5. � <br /> 2. All work ehell be performed In accordance with this permil and current City ol [verett Dc:sign and Conslruction � m� <br /> Stendards and Specilicaliona. fn <br /> 3. Call Locatlon Underground Servica 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> I�/i qNy� ./UElEfS9�j/ rEin/�C.E'q[�/ �<'OS.L��/ A•c/O SFU.inf.✓Ti�n/ � � <br /> CON�oL /S 7n t7E� lk�nlE .�.� D..C'F�/.Fi� 6 j/ 7,yE C/�� O 1 m <br /> %�L�.�.+'L/L /LI.�;`_'CS J-iV.11�Fl.'Cl<� • ` • �° <br /> ■ � <br /> x <br /> � a <br /> z <br /> � <br /> O <br /> � <br /> a Z <br /> 0 <br /> � <br /> �:, <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ____,��0 G e.�� S'/fl�-�—��_ ��.J` The undr,rsigned owner/applicanf hereby agrees to hold and save harm- <br /> � " less the City ol Everetl Irom any end all claims lor damages, costa, <br /> " expenses, or causes ol aclion that mey aiise because of installation <br /> � O.1 �., �6 and maintencnce of the improvement or othr.r nght-ol-way use heroto <br /> � applied lor and furihor aB�eeg �o remove ssme upon notice hom tho <br /> App�� tl fo.�01 on Da�e Gity and to rePlace Public ProPerl)'damaged ihereby. <br /> �'��� ����- _ � � 1, t��'/ 1��� <br /> FINAL INSPECTION Date <br /> Approved ae Consiructed Signa ur � I, p cant Date <br /> evereft PUBLIC WOFKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 i.eder St�eel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 90201 BE DILIGENTLY PURSUED 10 COMPLETION. THIS PERMIT MAY BE <br /> Phona: 259�8815 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK GN THIS <br /> PROJECi OVER 90 DAVS DUFATION. <br />