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s ��— is� � <br /> Pwnc Worb Parmn• � <br /> Dat� aiao om� • <br /> Application For <br /> PUBUC WORKS PERMIT °"°To:��`"° s <br /> Lee��pp���ae PaiE s <br /> a.��n o�� : ti'o �yA.,« <br /> Print or Type Only <br /> � �� J-0 / - '' .t ✓1. -��. ., -> <br /> [r � Phone <br /> Owner <br /> Meiling Address ���Y Z�p <br /> - — --'--—..-_"- --- --- � —�----- � . z <br /> Ci� ZiP Phonn � <br /> Applicant Mailing Address Y <br /> c� <br /> a m <br /> Describe Proposed Work �2 X <br /> � 2 � Tr"r�zi 7 /�i<,V G'• �l�g �G A170% S/l�l- [.(/F�a/C'_ . <br /> ...-. <br /> N !/L r-' P -� " �J� j'f�un /r,� T�39�vr/✓� � R.,� /�.� . ._ � ✓i'�--- — -, �7 <br /> --t-E'�' T _ _ � .. -i <br /> ` � �n x <br /> m <br /> %Z/�c. . _ �`' c o <br /> — � m� <br /> prolect Addres.lil known) — p m <br /> Attach tour 14) copies of plans for proposed work-Draw to scale and note the lollowing as applicable: � _ � <br /> • Property Lines • Genterlinn of sireei m <br /> • Outline and dimensions of all existing and • Indiwie Norih Q Z <br /> proposed siructures on�he lot • Show any propo,ed grading changes � <br /> • Er.isting and proposed utilities • Show mee.urements M � _ <br /> t. W � � <br /> �"� OU NOTv/Fln�_ ..c'.OW THIS IINE O '< <br /> � <br /> O A <br /> PEfiM1T GONDITIONS T <br /> 1. All calls�or inspeciion shall be made 24 his. in�dvance� phone 259•881 5. � --1 m <br /> x <br /> 2. All work shall be performed in accordance with thls pe�mil and cunent City ot Everelt Design and Construction m � <br /> N <br /> Standartls and Specilications. � <br /> 3. Call Location Underground Service 4B hrs. be�ore you dig.TOLL FREE NUMBER 1-800•424•5555. p m <br /> c v+ <br /> O 3 N <br /> m <br /> zn <br /> .�m <br /> b <br /> � p <br /> --1 <br /> S <br /> 'A a <br /> "♦ z <br /> O � <br /> � <br /> N <br /> a Z <br /> 0 <br /> � <br /> .. <br /> . � <br /> m <br /> ACKNOWLEDGEMENT OF GONOITIONS <br /> 7he undersignr.d owne�/apP�icanl hereby agrees to hoid and save harm- <br /> less tne Ciry ol Everetl Irom any and all daims lor damaBes. costs, <br /> expene:s. or ca�ses ot aclion �ha� may arise beceuse ol installa�ion <br /> ��� �S•5, and maintenanca ol Ihe improvement or other right�ol•way use here�o <br /> �-� � applied tor and furiher agrees to remove same upon notice Irom Ihe <br /> � Approved for Cor strudion Date City and to replace public property damaged thereby. <br /> ��-�---� � �y�.� � ���`-� <br /> � � <br /> �t .f��,-��ri�,- f,�Y,�.���.. <br /> FINAt INSPECTION Da.e Date <br /> Approved as Consiructed Signature of Applicant � <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everctt PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERIdIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BF <br /> Everett.WA 98201 CANCELLED BY 7HE CITY UPON ANY STOPPAGE OF\'JORK ON 7HIS <br /> Phone: 259-BB15 PROJECT OVER 90 DAYS DURATION. <br />