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� � � <br /> � <br /> H ,/ <br /> C H N C � T 7`� <br /> �� ��! � ` �! . .-} PuEbc Wb u Permil. ��---_ <br /> y �j � D3tC_ 10/�1 . o�aa.o�oi.• 91/27914 _. _ <br /> �t y f) Application For _ <br /> ° � ° PUBLIC WORKS PERMIT �uoTowf^>`°° s <br /> � y � <br /> z Lese Ronl.Fm Ge�J S� <br /> `" � TD POSTING ���`� +_ �y� Be�a°�A°°a s=�5 — <br /> °� � O Prinl or Type Only � 002-3ZZ- 5'O-OoO-/7-89/ <br /> c� • R <br /> N <br /> � � 252-ZZ44 <br /> y � P•.vergreen Cemetery 9504 Broadway � Everett, WA 98203 <br /> y Owner <br /> Mailing Address � City Zip Phone <br /> �� <br /> OC N <br /> � L*J t' h'tpct N li?� (' �7^ Ct � k WA Q9�n1 L��n ARfi 657i <br /> tv il Phone <br /> .� tn �1ppplicant Mailing Address ���Y Z P <br /> N 1 <br /> DescribeProPosedWork Mac��leum addition L(IQ�P�` /Y14-�i7�iY✓afP/ f':��OC4fi!'/)- <br /> ��� <br /> _ W <br /> Prolec�Address(if knowN 9504 Aroad a}r — � <br /> �7 <br /> Attach lour(4)copies ol plens lor proposed work-Draw to scale and�ole the lollowing as applicable: � <br /> • Property Lines • Cenlerline ot street <br /> • Outline and dimensons ol all existing and • Indicate Noith <br /> proposed structures on tM lot • Show any proposed grading chTnges <br /> / �- • Exislinu and p�oposed utilities • Show measurements � <br />' I C�' ���� DO NOT WRITE BELOW THIS LINE � <br /> i � ' PERMIT CONDITIONS � <br /> � �� 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•881 O. <br /> 1� 2.All woik shall be pedormed in accordance with this permit and current City of Everett Design and Consiruction <br /> StandarAs and Specilications. � <br /> � 3.Call Location Underground Service 48 hrs.betore you dig.TOLI FREE NUMBER 1•800•424•5555. <br /> �..,� �C',r I • �1�4�C4//Oh n ^s�i.� O <br /> �; 1�� �� �LL�K✓ c�"�y S1G„�� .,. n d f- <br /> � <br /> �.,.M 1 � <br /> � <br /> V � <br /> 1�� <br /> II I <br /> I �,I ACKNOWLEDG['dENT OF CON�ITIONS <br /> �� TIre undetsigned own^_r/applican�hereUy agrees to hold and s�ve hann <br /> � __ -- — less llie Cily of Evereil Irom any and all claims tor damages. costs. <br /> eapenses, or causes ot action ihat may arise because ol inslallation <br /> � /J and mcinlenance ol ihe improvement or other righbof-way use hereto <br /> G J -l�n`Z- �2�20 -9� applied for and Iwther agrees le ramove same upon nutice irom the <br /> Approvyd�:�o�Constru t�on - �a�� City and to replace public pr perty damaged thereby. <br /> � l .f����('fG:i ./ �.,��2 : ,. / Z � <br /> FINA INSP TI � [' ��1e �� �. <br /> Approved as Constructed Sic�nature of A plic�nt <br /> WORK AUTIi RIZED 6Y THIS PENMIT MUST BE STAPTED WITHIN <br /> � '« � PUBlS:WORKSDEPARTMENT ' 1g0 DAYS OF DATE P[RMIT i5 ISSUED AND THEREAFTER IS TO � <br /> '�� 3200CedarStreet BE DILIGENTLY PURSUCD TO COMPL[TION. �HIS PERMIT MAY �E <br /> Everett WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phnne�.2°9�8810 PROJECT OVER 90 DAYS DURATION. <br />