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„;; < <br /> Det9�� r�mK woa.rvmu. �S�_ <br /> Appllcatlon For eiap o•o�-• Y�� Y'��"� <br /> PUBLIC WORKS PERMIT Pu0lkWork�F�� <br /> ,o,.�F.. •_ <br /> �a..�oo�n.a�w • <br /> P�Int or Type Only e.i.��.o�. • 9s n� _ <br /> �s9 s� <br /> /3.-/2 �eso�;wf, / y� 9 �,��...lZ...,, �....�r s�>o . ��-� -�iu6 <br /> Owner Mailing Address ity Zip Phone <br /> �T- � /..iw �A.c� /Y�9 /.�.�o..D�...� 6.,_,...iY S8'1 �i .�s-a -���c <br /> Appticant Malling Add�eas Y ZIP Phona <br /> Describe Propoeed Work /�'^' / �'^� ���` <br /> .. �� - W <br /> �� <br /> Prolect Addreee pf known) �+o- �`”`T�?',�. E•���+-� � � <br /> Attach four(4)copiea of plana lor p�oposed work• Oraw to scale e��d note the following as appliceble: � <br /> • Property Llnen • Centerline ol street � <br /> •Outllne and dimenelons ol ell exiatinp end • Indicele North <br /> propoaed ntructures on the lot • Show any proposetl greding changea <br /> • ExletlnQ end p�opoaed utllitiea � Show measurements � <br /> DO NOT WRITE BELOW THIS IiNE O <br /> PERMIT CONDITIONS <br /> 1. All calle lor Inepectlon shall be made 24 hra In edvance•phone 259•BB1 5. � <br /> 2. All work ehell be pertormed in eccordance with ihla permil end current Cily ol Everelt Design and Construction <br /> Standerds and Speclflcetlona <br /> 3. Call Locatlo�Underpround Servfce 48 hra. belore you dip.TOLL FREE NUMBER 1•800•424•5555. � <br /> f,/ TO BE CONST,QvtfEO �E� p«Ns O <br /> �4���OVEp Ll�t/� 44TE� -3'�''�'S . <br /> � pF.P� - - - /i.wo . � _� ,- n�� - � <br /> � , <br /> �Li�= � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicen�hereby agree6 to hold and ae�e harm• <br /> less ti�e Cily ol Everett Irom any end ell clalma lor damepea coat4 <br /> —' ` e�penses, or causes o� acfion thet mey erise becauae ol Inetelletion <br /> �L / j-� L /l J%�/�s, and melntenance of tha improvement or olher righhol-way uee hereto <br /> / /L91� PJ"7 '��1 applied br and lurther egrees to rmnove seme upon notice irom tha <br /> Approved lor Construclion a�e City and to replace public propeity dnmaged thereby. <br /> � ��r/�,q.• io-Ff C�' ��-7�� 3 a <br /> FINA INSPECTION Dete �'`q'�"� <br /> Approved ae Conatructed SiB'awre ol Applicant De e <br /> everetl PUBLIC WOHKS DEPAfiTMENT WORK AUTHORIZED BY THIS PERAl1T MUST BE STARTED WITHIN <br /> � 3200 Ceder Sireet 1B0 DAVS OF DATE PEHMIT IS ISSUED ANO THEREAFTER IS TO <br /> Evorett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:259•BB15 :ANCELLED BV f HE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />