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Date. %7 .5';I . ;,, (/���C1 f: . � � .: � � r„ox�woo-en«�mn. _�'7�J� JJ' ✓ <br /> .��1 <br /> � � umc oeu� . <br /> Application For <br /> PUBLIC WORKS PERMIT °°°:o;F�:`°° S <br /> •eee�i.p� fee Pe�� S-- <br /> Bebn�:eDue S '�� C ' <br /> Print or Type Only <br /> � <br /> /�.�1��„ k I r�1 I��r _ <br /> Owner Mailing Address City Zip Phone <br /> ^ n5i �, I �� �7�!' �� 7-�S'�/G <br /> (%�'�,(� �O SGL `>. �vfe��, S . l � <br /> Applicanl PAeiling Address Cily �p Phone <br /> Deac�ibe Proposed Work � /- � �� �� �� � � � � �j � � � � � <br /> � �,� � �..Fr�-� <br /> S V <br /> Wi��-C_ �-� �-v��c�.i �tn.,� s , i�e%�w.S 'i� [� •t� <br /> 4�P�,o�_�� .�,��� �.,,�E n,�, ��� W <br /> Pro�ect Adtlrt ss 111 known) �1 ` � (^ ���� �v� '=+ l v� � �� � <br /> Atlxr.h tou�(ai coples o' plans lor proposed work- �iew lo scele end note�ha lollowing es appliceble: � <br /> • Property Lines • Centerllne of street � <br /> • Jutline e�d dimenalons of ell existing and • Indicate North <br /> ,�roposec atructures on tha lot • Show eny proposed gredin0 changes <br /> • ExistlnB'md proposed utillties • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> . AERMIT(:ONDITIONS <br /> 1. All cell:�lor Inspection shall be metle 24 hrs.in advance• nhone 259•881 5. � , <br /> 2. All worn shell be performed in accordance with ihis permit end c�rrent City ul Everett Dosign and Consiruction <br /> Standcrds end Specilicetions. <br /> 3. Cell Location Underground Service 4P hrs.before you dlg.TOLL FREE NUMBER 1�800•424•5555. � <br /> �� /.UCJL'� OO.<IE PE.� S/,!J/_'T �2AT �/[�- �`Tli-'� O <br /> .S C.s�«-+�cJ n,�i �'.—.��•sr�0 SrF;�_�' � <br /> ivi�i�� ii:isNn ouoAaasos � <br /> i ��1000895�8 <br /> Df'T.�Q 420.00 � <br /> CHEC1: 220.a0 <br /> AC,KNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl here6y agrees�o hold und save hnrm- <br /> - — less Ihe Cily ol Everelt Irom eny end �II cleims lor damages, cust& <br /> , expenses, or causes ol e n thet mey arise beceuce ol Inste:lotion <br /> r- �1 µ /jc .��� --� and meinten nce af Iha rovement or other ri hPM�wa use hnreto <br /> L.��/ ?L C I�� - �7 ' /. 9 Y <br /> epplied for n luriher ees to remnve seme upon �Mice hom the <br /> Approved for Constr ction � ete City and to epl ce pu � pioperty damagad therxby. <br /> (/ / <br /> X(� � , - , • �l,_ -�� � ,� <br /> > � h � ' (.Ci ,(,��(, <br /> FINAL INSPECTION � Date _ <br /> ppproved as Construcled �,, i 1 Sighetu.e ol plicent ate <br /> J WORK AUT RI2ED BY THIS PERAIIi IAUST 2E STARTED WITHIN <br /> everett PUBLIC WORKS OEPARTMENT �g0 DAYS F DATE PERMI7 15 tSSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLV PURSUED ��O COMPL�TION. THIS PERMIT MAV BE <br /> Everetl,1NA 98201 CANCE�LED BY TNE CITY UPON ANY STOPPAGE OF WORK ON 1�H15 <br /> Phona 259�8815 PROJECT OVER 90 DAYS DURATION <br />