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� <br /> i <br /> f>.��e�, .,� <br /> � <br /> �k:+: E4, �*SF.� . <br /> d,w,y.� .,. '�...,.� . ..'.� ,. <br /> �. <br /> �lY� Date�y(/ PUCI¢Wod�Plrmit� <br /> �H / i M — <br /> � � Applicalion For eiap.0�ni.•��,y7�� <br /> �yy PUBLIC WORKS PERMIT <br /> PULbc WorYs Fee S <br /> N '� Toiei i'ce . <br /> F? N <br /> K � �eseAopl.feePaN S _ <br /> O x O Print or Type Only eaia��e o�e S. <br /> 'b�� 'C <br /> V1 H <br /> � <br /> H <br /> �"� d ,F_✓prp JJ � P.c.r.aan/ �roa�r��,�s .���a� Si,�3� L,. �iA����zaG -zs9�s! <br /> O�� Owner �y Address City Zip Phone <br /> �� g <br /> �'` �CCC��� Sa,� <br /> �y� Applicanl Mailing Address City Zip Phone � <br /> wy T 1 ��T <br /> g y Describo Proposed Work _J.��j.{�1 �YY; .l��j�u — (�����(,���/p,_. a ry-n r2C <br /> �� J <br /> � <br /> y� y W <br /> /J �/ 7,� � <br /> . . . Pioject Atldress UT Anown) � 7�-� �h��Jd-___ly�(fQ Su,7'e�, � <br /> � Attact lour(41[op as of plans for proposeA work-Draw Io scale antl nole the:ollowing as applicable' � <br /> • ProFerty Lines • Centerline ol stree� /w <br /> • Omline antl dimensions ol all ezisting and o Indicate North V� <br /> proposed shuclures on Ihe lot • Show any proposed g�ading change:; �.i <br /> • Existing and proposed utilities A Show measmemen(s Y,� , <br /> �O NOT WPITE BELOV!THIS LINL m �, <br /> � 1 PERMIT CONDITIONS � � <br /> 1 ' 1.All calls lor inspection shall be made 24 hre,in advance-phone 259•88�0. � <br /> � 2.All worY,shall be pedormed in accordance with Ihia permit and current City of Everett Design and Constmclion � <br /> Slantlards antl Specilications. <br /> '�� 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FpEE NUMBER 1-800•424•55Ei5. � � <br /> 1�' i <br /> ��, r(J� GJar� �cnm+-�-t/�'t /�a,�.ti� O i <br /> � <br /> ��� ���� � � <br /> —(I /i -- -9 0 <br /> � 0 , � <br /> - <br /> �" � <br /> ; <br /> �1 <br /> 's� ACKNDWLEDGEMENT OF CONDITIONS � <br /> � ' The undersi�ne�.i oviner/applicanl hercby ngmes to hold and save harm� <br /> � <br /> less Ihe City ol Everett irom any and all claims tor damaqes, cosls. <br /> , expenses. o� causes ol action Ihat may arise because ol installetion I <br /> -� � a id mamtenance of Ihe impwvemeM or other right-obway use hereto <br /> applied lor and lurther ayrees to remove same upon notice Irom Ihe <br /> Approved for Const!uc•ion Dale City and to replace pubhc property damanetl Iherehy. , <br /> FlNAL INSPECTION Date I <br /> ApProved as Conslructetl SignaWre of Applicant Date � <br /> everett PUBUCWORKSDEPARTMENT �NORK AUTHGRI2E� BY THIS PERMIT MUST BE STARTED WITHIN i <br /> � 3200CedarSlreet 180 DAYS OF OATE PERMIT IS ISSUED AND TH=RE.IFTEP IS TO <br /> Everelt,WA90207 BE DILIG[NTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phon�:259-xEnO CANCELLED OY THE GTV UPON ANY gTUPPAG[OF WORK ON THIS <br /> PROJECT OVGR 90 DAYS DURAiICN. <br /> I <br /> I <br />