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Oate_��'' o�e�������..P m,�. <br /> � —.3s� <br /> eiav oac:• � <br /> Appiication For <br /> PUBLIC WORKS PERMIT °°°T�:��`° s <br /> Le+s noo�.Fea Pna S <br /> BSlenceDue s 29� <br /> Print or Type Only <br /> �3��� � <br /> �����p��2S /y4S<� ��� a���`= O�' . Na� .13������ y.sy�'r,� <br /> Owner Mailing Atldress C�ty 2fp Phone <br /> `J �(T� �� ' o <br /> Applicant Mailing Adtlress Gty ZiP Phe°e � <br /> � � <br /> ^1 m <br /> Describe Proposed Work <br /> 'V � � �.Q� � .. <br /> .. .. <br /> - -1 �t <br /> .. --� <br /> W `� _ <br /> m <br /> c O <br /> ��3/- — '.i.- m o <br /> P�oject AOdress Qf known) � <br /> O 3 <br /> Aflach fom(4)copies of plans ior proposed work-Draw to scale and note the foflowing as applicabie: � m <br /> • Property Lines • Genter�ine o1 stieet � = M <br /> m <br /> • Outline and dlmensions ot all eaisting and • Indicale North <br /> • Show an ro 9 9 Q <br /> proposed st�uctures on the lot y P posed gradin chan_es � <br /> • Existing and proposed ulilities • Show measuremenis M � _ <br /> W -i N <br /> DO NOT WRITE BEIUW THIS LINE O < T <br /> PERMIT CONDITIONS � D <br /> i. All calls ior insDeciion shall be made 24 hrs. in advance-phore 2S9•H$1 5. � -1 m <br /> 2. All work shall be perlormed in accordanCe with this permit and current Gity ol F.ver?tt Design and Construdion = <br /> m •» <br /> Standards and Specifications. � <br /> 3. Catl Location Unde�B�ound Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � o r <br /> nm <br /> C N <br /> J� S,rE Lr,o,c',r ;0 6'E Co.vsrc��,-E o PE,e A.'r'�'ovEL' O = � <br /> C'C!�'n/ D�GTE� /�.�o�9G, � n <br /> z <br /> S 9L t /if/o.0� /S %o dE OnNE /�E�' Tf/E ti`'Eq,1./_'�/�/e`ti'S � i <br /> vf SEPA '¢i2Z-8s � '_ <br /> -� <br /> �. �9f'f'���.�.vi' i,�' To .�',Pu✓.oE A �c'�eFo.e�n4�✓c� � � <br /> � <br /> C�i/�1,CA.vij/ �.E' Sno.e'odEinEN1.f /rU �dTiif_� f�o%�i. � � zo <br /> Gl/,4y /N %f1E /9iyrot/nJi UF ///ZpGrJ �-�- <br /> R.��rr—�- � <br /> ,t�e�CEiII/E� ,��'//-B6 � �" <br /> ACKMOWLEDGEMeNT OF CONDITIDNS <br /> The un�ersigned owner/applicant hereby agiees to hold and seve harm- <br /> — lass �he City of Everett Irom any and all claims loi damages, cosis, <br /> expense�s, or causes ol action that may arise because o1 installation <br /> `�'P � � � s/�k� and maintenance c11he imDrovemenl or other righLof-way use hereto <br /> .r �fi ��7l�'D-��y applied for and furiher agrees to remove same upcn notice irom the <br /> Approved for onstrt�ction late City antl'o repl;ce public propeity damaged ihereby <br /> / , ^ <br /> / / J � <br /> '01 J�--�6 _ �i .G ..} ��°1��S�o <br /> � I SPECTI� Datce h Date <br /> Approved as Construct��d S�ol Appilcant � <br /> WORK AUTHORIZE=D BY THIS PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLIC WCRKS DEPAFiMENT �gp pq�;, OF DAnE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200 Czdar Street I gc uiLIGEIJTLY PURSUED TO COMPLETION. THIS PERId1T MAY BE <br /> Everetl WA 98201 CANCELLED BY�HE CI?Y UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-0815 PROJECT OVEfi HCi DAYS DUFiATION. <br />