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�C, � f���(/�J// <br /> � � <br /> C� H �.1 _, /^ /A(y PuOi�cW�r�sFein��• `� yj_�-- . <br /> y y y Date�. ��� 5 6 ema o.oi ._—���— � <br /> ��� Aoplicallon For �� � <br /> PUBUC WORKS PERMIT �u�i,cNorMefee S <br /> �� I TolalFce II <br /> Lesa�pPl FanPo�E S <br /> Oy � BahnceDue S '. <br /> �o� Print or Type OnIY �I <br /> H <br /> o '� �y � ✓e/e/tt �1cQo2G/ r� S�,`-3Sl�`' <br /> �L'�+70 ��C�tnr�' I ��S�� ���1J 1 fiih__� Pnone <br /> Q` n Owner Melling�ddress � ��1' Z P I <br /> H <br /> zH <br /> � H H �Pu��� — Mailing Address City Z1P Phone <br /> gN <br /> d� ` �Ca�n r�,M .o.u.�' I <br /> C (`l h i'C� <br /> C+]� Descnbe Proposed Work <br /> H f/� ' <br /> HOcn <br /> W <br /> Pwjecl Address(il known) �� ' � <br /> � — <br /> Attach�our(4)copies o� plans lor P�oPosed work-Draw t scale and nute the lollowing as applicable i <br /> • Property Lines • Centerline of street <br /> • Indicale North � � <br /> • Outline and dimensions of all eaisling and � Show any proposed pratl�n9�nanges ', <br /> proposed slrucWres on Ihe lot � Sho�v measuremenls � <br /> • EzisGng and pwposed ulilities <br /> DO NOT WHITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS � <br /> �"� �- � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> C� 2 All work shall be pedormed in accordance with Ihis permit and c���wN City of Evereil D�+sign and Construction <br /> Standards and Specilications. � <br /> i � 3.Call Location Underground Service 48 hrs.betore you dip.TOLL FREE NUMUER 1•800•424•5555. <br /> � <br /> ; <br /> �_� ,� p.� �,-���,�s r.'rt � � %s=�s Q , <br /> � <br /> I ' ,,—' _ cn <br /> O <br /> __ , a <br /> ��� �� <br /> I ' ��' ACNNOWLEDGEMENT OP CONDITIONS <br /> i � <br /> , The undersipned owneUapplicant hercUy agiees Io hold and save �:��ii�� <br /> � less the City ol Everetl irom any and all claims lor damages. costs, . <br /> ezpenses, or causes of aclion Ihat may a�ise because ot installalion <br /> ` �l '�.�i� and maintenance ol lhe improvement or other right-ol�way use hereto <br /> ��`� ��-f�"" / ���� applie� lor and Iwther a9rees lo remove same upon noUce Irom Ihe <br /> , A �ved lor C uc 'on ,� ate Gity and t�o���77eplace public property damaged thereby. <br /> I ,'/ � ,� ,j'�–��_ iL�-yS'Y�i�` ` / I�E �( <br /> FINAL ItJSPECTION � Date Da e <br /> Signalure ol Apphc•�n� <br /> AppmvedasConsir�cted yyORK AUTHORI�[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> Oevrretl PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERAIIT IS ISSUED AfvD THEREAFTER IS TO <br /> 3200CedarSlreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED�Y iHH CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona 259�8810 PI70JECT OVEN 30 OAYS DURATION. <br />