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� 1 <br /> y � --- <br />� Date I � �i I�" -- � v�ei�c wo,w Pe�mn��y 1`�n <br /> � i . Biap Devt• �"f�l '-����J� <br /> Applicalion For <br /> t� PUBLIC WORKS PERMIT P�blkWorWFse <br /> ,�.�F� s :f-v. a o <br /> 1 —�� Leea Appt fee Po�C a <br /> L <br /> e.u�uo�a s �o• o n <br /> Print or Type Only � �D � � <br /> r ��-�=i i�� � � ��i� �� �H S A�'� r l ( ,T ,�f��,- � � „-t,� rf- ri� ;: - '�i / � <br /> Owner Mailing Address Crtyr Zip Phone <br /> r, i II <br /> � - L4 � .� � �� 1 ' � ;�" . if_ C/�%' � ��'.I <br /> ' � � .. �i 4�'1 � 1� � � � �.}��6iL{4.i �P ' � :f- L �'��,� » � � r' � /_ <br />; Applicant� ' Melling Addresa V Cdy �Zip Phone , <br /> I� OeacNbe ProPosed Work ' � "., -;� �,j ��.�� ��^ .i • ')y -i ,i r, I <br />' U <br /> I I <br /> W i <br />' nroiect Address(il known) ' �'�rl ( �+ � {-�`�1 -- � ' <br /> Atlach tour(4) copies of plan6 lor proposed work• Draw to ecale and note the following as applicable: � <br />' • Property Lines • Centerline of sfreet � � <br /> • Outline and dimensions ol all existing and • intlicate North <br />� proposed structures on the lot • ShOw any propo5ed grading changes <br />, • Existing and proposeA utilities � • Show measurements � <br />� DO NOT WAITE BELOW THIS IINE O <br />� PERMIT CONDITIONS <br />'i 1. All calls lor inspection shall be made 24 hre. in advance-phone 259•887 5. � <br /> 2. Atl work shall be performed in accordanCe with thie permit and current City of [verefl Design and Construction <br /> Standards and Specificalions. <br /> 3. Call Location Underground Service 49 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> 'f! rF!'c-`•�'r,�:S .'3�I,(�<„i,.�_� !�_ T �a.J +.'��1'f/i:`� ="��r c/'- O <br /> f�'LGry� �'Jard� n-��- ��iq� r/�-,!"y G��o�o �.�..�..,-,,,; - . . _ <br /> _'" n r" r�..S c U �'/� EiY!/�G r;Y'cc�' c../il i. � .. . .. ,__ � <br /> � . , � � i- . � <br /> O <br /> i <br /> a <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> The undersigned owner/anP�icant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all clalms for damages, coste, <br /> �, � . ,.� expenses, or causes ol action thal may arise because ol installation <br /> . --- - �� •�. � and maintenance of the improvement or other righFol-way use here�o <br /> �� � � - ���'� applied lor and further agrees to remove same upon noBce from the <br /> ApPrOved lor Cg(islruction /" �a�e City and to replace puolic property damaged fhereby. .y <br /> `. " � � .� ' �I -� � y � � � <br /> �% � �%� " % � i � // � / <br /> � FINAL INSPECTION Uete �,�.z� '�7'.�� �� � �j•- �' _ �"�y/'f f::v z�,'`{� .� ��i <br /> Approved as Constructed Signature ol Applicant � / Date , <br /> « PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV.'YHIS PERMIT MUST BE STARTED WITHM � <br /> evr�: 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO . <br /> �� 3200 Cedar Slreet BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE � . <br /> Everetl.WA 98201 � <br /> Phone: 259-8875 CANCEILED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. ' <br /> � ' <br /> � <br />