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r�--� <br /> Date�6 <br /> Pe01.r W�.:y YQrnIX� �-�� <br /> ApPlication For ewp.oeoi • � <br /> PUBLIC WORKS PERMIT P�°�Kwo�.�� <br /> Tm�i Fee f��. <br /> Lesi�pp�Fee Pua 6 <br /> Print or ?ype Only e,�.�,o�, 5_il/O Cy�l,C< < <br /> �.c/ �UGErr/ .�'23/-�,poqau:p� EdE.eETT <br /> Owner Mailing Address C��y <br /> ZiP Phone <br /> DOcic /5�-32.3 - N,6, ,��,�r�s <br /> 4'9.AT.CU/n �1/O.�TyS p z <br /> APPlitanl � 4'.or L"Ec ,u� � !*,�i�ao�.,�u.�GE.' S/9/ 7/t<S � <br /> Mail�ng Adoress City . zip <br /> Phone �j <br /> m <br /> Describe Proposed Work " <br /> -- �9 1Jli�sf�J'Tc�.e i�SJ QG fEY b�� --- -a i <br /> , �li.cip <br /> 1f'iiC/G Si�F ��f/c»'o C�iiiGd�w/lr � - in = <br /> iZST m <br /> �U/L�ijt/fT Oi[.J / � <br /> ldES"T SiQ� 9[L E � m o <br /> Project Adtlress�if knovm) .�'�-3/- 8,.eoy � � <br /> � 0 3 <br /> Attach lour(4)copies o�plans lor proposed work- Draw to srale antl note the�ollowing as applicable�. m <br /> • Property Lines • Centedine ol sireet <br /> � m � <br /> • Outline and dimensions ot all existiny z�d � C Z <br /> P�oposed structures on the lot • Indicate North <br /> • Existing an�proposed utilities � Show any proG�sed gratlinG changes a = <br /> • Show measurements ,.., ,..,, <br /> /y� � w <br /> DO NOT WRI;E BELOW THIS LINE W �7 <br /> PERMI�;CONDITIONS O O D <br /> J 3 <br /> . t. Ail calls tor inspection shall be madc 2a hrs. in ativance- phone 259•887$. m <br /> 2 All wo�k shall be performed in accordance with ihis permit and current City ol Everetl Design and Construction ' m ~ <br /> Standards and Specilicaiions. �+ <br /> 3. Call Location Underground Service 48 hrs. belore ou di TOLL FREE NUMBER 1-$00-4? O r <br /> Y 9' 4•5555. <br /> , - c vmi <br /> ( 3 v� <br /> r {f � '` ,/ �^ <br /> � I����_ ,_. �u_��,i r3.u_�1 L. iQf� �-zs.� /ti{r� 'A V t r' Y O � m <br /> , � ._ -./�/ �. ��;� �� , , y <br /> L� l4 -�� i����,Q� (// / l� _ /j� JO <br /> �. Vr.�+ A_I/fJ1� � -i <br /> � O S <br /> . � �• • . : r , .r �.'t1.:J .:.�� �:r�-. �.IF .:.� . .: t . / .1 , '�w 2 <br /> � I' _I -i <br /> .-_. <br /> O N <br /> Z <br /> O <br /> a � <br /> � <br /> m <br /> _ � � .? �. " ACKNOWLEUGEMENT OF CONDITIONS <br /> . The untlersi�ned owner/applicant heieby agrees to hoid and save harm� <br /> �ess the Ciry of Everett trom any and nll claims for tlamages. costs. <br /> ----____c_!�2.� �o�/ T e%Penses. or causes of acfion ihal may arise because ol installat�on <br /> — ?�_ �jBG and mainlenance ol the improvement or other right-ol�way use lie�rzto <br /> APP•oved loi o,istroclion Date applied for and furlher agrees to r=move same upon notice Irom Ihe <br /> � -��%- / City and to replace public p�operty da getl thereby. <br /> i _�' �, �� 5%y d� , � <br /> RNAL INSPEC710N Dale � � � " <br /> Approved as Consiructed �"° %�1';i <br /> Sig ature of qpp ica�C ' Datc <br /> rvrrrtt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TPiIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 1�0 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTEF IS TO <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO C01,1PL[TION. THIS PERM1III MAV C-L <br /> Phone:259-OB75 CAIJCELLED BV THE CITY UPON ANV STOPPAG[OF WORK GN THis <br />, PROJECT OVER 90 DAVS DURATION. <br /> , <br />