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i <br /> � Applicatlon For �- � � <br /> � PUBLIC WORKS PERMIT De�°— '�`�`'% �7 � <br /> � PUBLIC WORKS DEPARTM T � / G O I <br /> � 3200 Cedar Street � Public Nbrks PertnH M , <br /> � Everett WAB82 7 9-�970 i <br /> Tp pnsTi�i r, S�EP 1 g 199� � e�nainp Parmu• ���xv i -- <br /> — i <br /> , , : , �„ <br /> TYPEORPRINTONLY ;', ,; ��, ,.. , ,_; �; Ipuyl�c,WorksFeeS� _ I <br /> �,� � i <br /> i � � '_ «, .. . ., i <br /> N:CIf-l.Uif li�C 141rL4 b4'I'I: AGi�. 6 LUI���IFUS, 9b�'!.b "r4..-7L5_ <br /> I Owner Melling Address � R. -�—c., ,:� .�: ZI� � ` ,� Phor�e � <br /> � �i ,i i,. '. r.' <br /> . C r.� r � � i.; <br /> � AGI�ULU ULSl�Ai1 ti5&-Y��4.: � � i ��'��� i.� ��� ` - �'� �I <br /> �� Applleant Malliny Addreas � Gty ,Zip I Phona �� i <br /> i <br /> � DescribeProposedWork i:t.s: ifuus,; „ ■ ■ i <br /> � iW <br /> i � <br /> � _ roZo c�,;noo � U� � I <br /> � <br /> � PROJECT ADDRESS(if known) . . .': i ,�'i ; � , <br /> � Attech four(4)eoplee of p�ena}or propoaed work-Draw to ecele end note the lollowlnp If eppllcebla i <br /> �, 'Property Unea �Outllne and dlmenaiona ol ell exleting end propoaed structures on the lot •Exletlnp and proposed utllitles O . <br /> �� 'Centedine ol etraet •Indicate North 'Show any propoaed pradlnp changes •Show meanurements � I <br /> � DO NOT WRITE BELOW THIS LINE � <br /> i PERMIT CONDITIONS; � � <br /> 1.All calls for Inspection shell be made 24 hours In advance-phone 259-8810. � <br /> 2.All work shall be performed In accordance wlth this permft and current City of Everett Design and <br /> � Constructlon Standards and SpeGficetlons. i <br /> 3.Call Location Underground Servlce 48 hrs. before you dlg. TOLL FREE NUMBER 1-800-424-6568. � � <br /> � <br /> O <br /> a <br /> � <br /> � <br /> G�� / � � ACKNOWLEOOEMENTOFCONDITIONS . <br /> / �- � / The underelpned owner/epplicant hereby aprees to hold end eave heimlese <br /> the City o}Everett from any and ell claima lor demepes,coete,ezpenses,or <br /> rovetl for Co y�ctlo . ate causee of ection thet mey edse because ol Inetallation and malntenance of � <br /> /� � tha improvement or other right•ol-wey usa herato applled lor entl further epreas <br /> to remove seme upon natice fmm the Clty and to replece publlc property � <br /> ' ;��� � �-f� demeped theraby, i <br /> i FINAL S TION Dete ' - � ' <br /> ; ApProved ea Construeted � � i� ;((�:' � /, .. '� <br /> ��� � ' � //���/ ���� � � � � i <br /> i SlgnetureolAppllcant �� Date <br /> �I WORK AUTHORRED BV THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREl,FTER IS TO BE�ILIOENTIV PURSUED TO ' <br /> i COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CI7Y UPON ANV STOPPAOE OF WORK ON THIS VAOJECT OVER BO DAVS DURATION. � <br />