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� _a..,._ . _=�.�,a <br /> � %� / <br /> Da te�_';�i <br /> Vuebcwo4�permit. ( !—��� <br /> Applicntion For omu beoi � <br /> PU��3LIC WORKS PERMIT <br /> ,� Pvehc Worb iee <br /> I <br /> Toleiiee S <br /> Print or Type Only � � �^�+Aom�ee Puo S / D <br /> ��� �alence pue s / J f? <br /> �' �• <br /> //�!' �7�! -% )�7 !�X �/!", /%.� (��_ /' <br /> Owne� n � '� �_ _ _ ; MailingAddress /l �,`;yflc' ���. �,9/�Y-12�» .�5/� r�=� <br /> CII C. 'J,'> �� <br /> '° •:� ,» Y Zi� Phone <br /> ni ,� :-� �; �� z <br /> !�l::i�,'•r t= =� f_i <br /> Applicanl Mailing Address <br /> Ciry Zip p�-- <br /> hone <br /> Describe Proposed Work �n� -r �-. � - <br /> ! �Cii�.0 `� C7� 7 / Cl"i <br /> ?i�� ?�.i�.c��., 111�. .S'c�c://� ����"_� ,_ �+--''�'��n� <br /> �;.,�� <br /> Pro�ect Address lif known� J llZ.�' (.�j �� _ �,� -�-- W <br /> � Si <br /> Attach lour(4)copies ol plans lor proposed work� Draw lo scale and note tho following as applicable. H <br /> • Property Lines • Centerline o�street � <br /> • Oulline and dimensions ol all existinq on� � <br /> proposetl siruclures on Ihe lot � Intlicale North <br /> • Exisfing and proposed utiliM1es � Show any proposad gratling changes <br /> • Show measuremenls <br /> DO NOT WRITE BELOW THIS LINE m <br /> PERMI7 f:ONDITIONS O <br /> 1.All colla lor inspaction shall be mede 24 hrs.in advance-phone 259•$810. <br /> 2.All work shall be peAormed in accordance with this permi�and current Cdy o�Everett Design and Consiruction ' <br /> Stantlards and Specilications. <br /> 3.Cell Location Undaryround Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800�QQ4•5555. <br /> /. ��riiC fr"' �'� ' c���n.'��'r �J�q.zS `(�/�rr;,��•c� .�� 7��<_ � <br /> ��v 1�.:C /r.-pr,(s c;{f��r•fi>-�c: .� 7` o� 7- .;t I-�/ O <br /> � �L��f�r i i 1 <br /> � n�S �.S T C.� ( �' l� <I�'�-' C P lJ� � n � <br /> /� / / t' 7U�ii'r. I t �� <br /> rt'i7(i'O ICi/�� � / <br /> �d �'� -�,� c..�f."L fhe EiS. �i/.��,_.l � <br /> /S ��r'.S�<.���:r� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITION; <br /> ��---�— The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> less ihe Ciry oI Everell hom any and all claims lor damages, r,osls. <br /> c_ -� �- �� / oxpenses. nr causes ol action Ihat may arise hecause of inslallation <br /> A �_��� / and mamlenance ol �he imp�evement or o�her righPc �wey use herelo <br /> PP�oved�for onsl�uu / e'e applietl lo� and �urther agrees to remove seme upon no�ice from the <br /> ��� //, /,� ��f � Cily and to replace public property dama�ed�hereby. <br /> / �l" r�-F� � i. / //'�- 1�� <br /> FINAL INSPEC ION � �Date� ��( /"��y(��..if-t�j , <br /> Approved as Constructetl ��zq 9 � <br /> Signatme or qpphcant Date <br /> PUOLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITFIIN <br /> 3200CedarSiroet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 9820i BE DILIGENTLY PURSUED TO COMPLETION. T�iIS PERMIT AAHY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPpqGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />