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i <br /> Date � ��"� �s� <br /> Publrc Work�Fermh� � .7J � <br /> Application For eiaa.oeo�.� <br /> PUBUC WORKS PERMIT P�b�,<Wo�.Fee — <br /> Tm..ioee S <br /> Les�AppL Fea Peltl 5 •— <br /> Print or Type Only e��a��s o�o <br /> sr. P��- uN,TE� MEr/��D�� �o �se�<Bt <br /> - P�r-�r-T 9�1�1 15'i 7��'/ <br /> Owner Madidg Address Cdy Zip Phone <br /> z <br /> 0 <br /> � <br /> Applicant ailing Address City Zip Phone m <br /> coN��-��r . <br /> Describe Proposed Work � �,/ 4 � � ' <br /> I�FTC«Z� C'c� _ --� � <br /> �'� � s �J „ .. .� <br /> � _ �, _ <br /> � cv �=c=� � c-�,� S o "' <br /> � co <br /> crJ i�£7[.''- � /US' � <c�f✓ . � m o <br /> Project Address(if known� CD O p L� 0 3 <br /> � m <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: ~ <br /> — m <br /> • Property Lines • Centerline of sireet � Q Z <br /> • Outline and dimensions of all existing and • Indicate Norih � <br /> proposed siruclures on ihe lot • Show any proposed gradmg changes <br /> r M <br /> • Ezisting and proposed ulililies • Show measurements –i v+ <br /> < <br /> T <br /> DO NOT WRITE BELOW THIS LINE � y <br /> PERMIT CONDITIONS O .1 m <br /> 1. All calls for inspection 3hall be made 24 hrs.in advance• phone 259•881 5, m '"' <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everet(Design and Conslruction � N <br /> 0 <br /> Standaids and Specifications. o r <br /> ['� m <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � � <br /> y ,�� s-T�v. �� �'��� Z �� <br /> ��% Cvy✓T,�9�' � <'// ' � <br /> y ����� � _ <br /> 7-�, � ' <br /> ����--J ��J �r��� Z <br /> /�i�'iv.� � c-�,-�,J sT,�l.i�'i�v�J . (/' N <br /> � 2 <br /> 0 <br /> � <br /> a � <br /> m <br /> ACKNOWIEDGLMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> 'e,s Ihe City of Everetl irom any and all claims for damages, costs. <br /> _�� e.penses, or causes ol aciion that may arise because o1 installation <br /> v .f and maintenance of �he improvement cr uther right-ot�way use hereto <br /> Appr vyd for Const ctio pa1e applied lor and further agrees to remove Same upon notice Irom ihe <br /> City and to replace public property Oameged there6y. <br /> ���������� �/- iY•fG ��!, � �- <br /> FINAL INSPECTION Dale �T/��� � �.�c.- �r,—r�—�3 <br /> ApDroved as Constructed Sig atu� re o1 qpplicant Date <br /> everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TNIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 780 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS VERMIT MAY B[ <br /> Phone:259-8815 CANCE�LED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJf_CT OV[(i�JO DAYS DURATION. <br />