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, <br /> . v' <br /> Date � . - '�� �_„��. w�,.�P,,,���. �-/2 <br /> AUP�iCa�ion Fo� e�,�a oeui a <br /> ���_. <br /> PUBLIC WORKS PERMIT . . — ---- _ <br /> ��.,����wa,,=�rr <br /> ,o�a�FaP s — — <br /> Ltl55 N19p1 FNE Pyip S_ ____ <br /> Print or Type Only La�e��:P o�N 3 �n� __ <br /> ��'t���(�'�'j1�1� di �18� <br /> �.1,-U�r(G(1' (� a,( C -T/A/1 'e� f_/��7 � r"I <br /> Owner Mailing Atltlress C:ty Zip _ p��pne <br /> � �( �I <br /> Applicant Mailing Address C�ty Zip Phone <br /> Descnbe Propoaed Work c�i—� / !, ll y___���. ���_�� <br /> C�' <br /> Proiect Atldress lit knownl �7�� - �C<.C� 7`��fyl✓ ___ — � <br /> Attach fow(4)cooies of plans for proposed work- Draw te scale antl note the following as applicable: � <br /> • Properry Lines • Centerline of stree� � <br /> • Outline antl dimensions of all existing and • Indicate Norih <br /> proposetl siructures on the lol • Show any proposetl grading chanyes <br /> • Existing and proposed utilities • Show measuremerts � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All worn shall be pertermed in accordance with this permit and current City ot Everett Design and Construction <br /> StandaMs and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00-424-5555. � <br /> / � (' 2CC^ � [Y7-u,��c a��, ,�Z�<� "h') ��k^ /��.Y6�� /y�C/c'�.) O <br /> . / <br /> �'rn C.i�z� G l, C���' ,/-.�". Cy-y�i)/;:jf>l �//r , <br /> �y �_"� �J/ J � <br /> �I�C�C'c <br /> �= � Gc,�t.1N �YtE-c.<� ^C//L[.c�a:u.?¢,c� �Q-'U �z. . S�c<.�r,�a?�7�#3P� <br /> / t\ � l ` �� � �� <br /> �C 1/tJ�`L C�L I�lJ F c�` �I^ C�F V��� � L L �',.� O <br /> � � x� s�-� ���� � � <br /> ACKNOWLEDGEMENT OF COND!TIONS <br /> �_ The undersigned owner/applicant hereby agrees to hoid and save harm- <br /> less the Ciry of Fverett irom any and all claims for damages, costs. <br /> expenses. or causes of action that may arise because of installation <br /> � ` J <J t antl maintenance of ihe improvement or other right-o��way use h,ereto <br /> �� '���f��-�� / ��� applied �or and �urther agrees to remove same uoon notire from Ihe <br /> 4pproved for Con ruction� " Date Cit place public property damaged thereby. <br /> �7�.-j%� X_ G-e�e��%Ci �/1 ��' .� � <br /> FIN PEC710N Date ' � <br /> Approvetl as Constructetl S natu e n�Applicart Date <br /> everett PUBLIC WORKS DEPARTMEN7 `NnRK AUTHOFIZED BV THIS PERMIT P.SUST 4� STARTED WiTHIN <br /> 0 3200CedarStreet � DAYS OF DATE PERMIT IS ISSUED AND THEF'EPFTER IS TO <br /> Everett WA 99201 8� JILIGENTLV PURSUED TO COMPLETION. ?H;S PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BV THE CITY UP_N ANV STOPPAGE OF WORK ON THIS <br /> PR03ECT OVER 90 DAVS DURPTION. <br />