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i <br /> I <br /> � <br /> yc�� <br /> D � x <br /> C H <br /> � H [n <br /> H . ^���.''�„'fe���i'� . <br /> H � <br /> r< c� <br /> y '� � � / Puciro�von�ve�m�t• <br /> �H O� Date��2Q . <br /> N " Applic�FOr � emy.0eo�.• — <br /> o� � PUBLIC WONKS PERM�T °°�°°W°,�.'°° � <br /> iobliee <br /> Le��Aoo�Fee Paia 5 <br /> .�.� ��i] g Beience O�e � <br /> H• o Frint or Type Only <br /> H� <br /> � N y - �x"".7�' mn�n � //��3��78�'�r�2 ��/ ��QUP, /�5.3-Z1v95' <br /> g�' =� <br /> � � y � Owne MaJmg Atldress Ciry 2ip Phone <br /> � Zr� ti � <br /> V i� Applicant MailingAddress City Zip Phone I <br /> • Describe P�oposed Work E 5 �i^�SSo ,Si`r.nc+� ��� /Xt�'.fi�9 c.Of <br /> ;� i <br /> 'i <br /> � 1 <br /> Project Atldress(il known) 20/S- C�roa�wa. C'�CSo�� rurh � �� <br /> � i <br /> AttaCh four(4)Copies ol plans for proposed work-Draw to SCale an0 nole lho lollowing as applicahle: s <br /> �-+ • Property Lines • Centerline of sireet � � <br /> � • OuNine and dimensions ol all existing and • Indicate North <br /> �� proposed strucWres on the lot • Show any pmposed gradiny changes <br /> ;: • Existing and proposed Wilities • Show measurements � I <br /> :� 1 <br /> ��1 �y 00 NOi WRITE BELOW THIS LINE � I <br /> 1 ' �; PERMITCONDITIONS <br /> � � 1.All Galls lof Inspection 5hall be mede 24 hrs.In advanCe•phone 2S�J•B8�O. � I <br /> 2.All work shall be pedormed in accordance wilh lhis permit and curtent City ot Everett Design antl Construction � i <br /> '�� �� Stendards and Specifica�lons. I� <br /> � 3.Call Location Underground Service 48 hrs.6etare you dig.TOLL FREE NUMBER 1•b00�424•5555. s <br /> ��i � <br /> '� �(J�/��.. /�Ou='z J��iY,+••!'�[�O( F-�"(/,lf[,u¢� C <br /> P`O � Q <br /> �_I � �'.� �., <br /> f '� /,�^y-y/ v <br /> i � � . C <br /> 4 '_� 7 _ ,.,. � <br /> '�� � <br /> �1 � <br />�I �' � ACKNOWLEDGEMENTOFCUNDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harrr <br /> � � Iess the City o! Everelt from any and all claims lor damages, cost: <br /> expensea or causes ol action that may arise because of Installatio� <br />� � � and mainlenance of the improvoment or olher right�of•way use heret <br />, , spplied for end further agrees to remove same upon notice from th� <br /> Approved lor Conshuctlon � � Date City and to replace public property damaged thereby. . <br /> � FiNAL INSPECTION Date <br /> R Approved as Constructed Signature of Applicanl Oata <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STP.RTED WITHI� <br /> PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSI��_D AND THERcAFTER IS Tt <br />� ' ��I� 3200 Cedar Slreat BE OILIGENTLY PURSUED TO COMf�ETION.THIS PcRMIT MAY B <br /> Everelt,WA98201 CANCELLED BY THE CITV UPON ANY�TOPPl�GE OF WORK ON THI <br /> , Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />