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._�� <br /> � <br /> n <br /> ��� <br /> � w <br /> � — Q� TO POSTING !— '—�r� ! ��,n�,�wo,ks�r�.m,,�^. �,��- ?/ <br /> � c� Date� u ' ?'�-1 I��� <br /> �1 M�il eiee oaei x .�-Tj . _.. <br /> qpplication For <br /> _' <br /> `°� PUBLIC WORKS PERMIT `°°"°w°'""`" $---� — <br /> .o,��Fe� <br /> �'Z'� �ess nnai.Fae aa�e $ � - <br /> H d �� <br /> Baiance D�c � <br /> N�ly Print or Type Only <br /> O <br /> QY � <br /> �y� Q,�i�t� ��-vr��� ��-3�,�. �� l ��l'� Ug�03 ���-�17�� <br /> hy H Owner <br /> aiNng Atldress C ty Zip Phone <br /> f� <br /> M �„ „�s� <br /> Ot7G° c���Ylr� pty Zip Phone <br /> C��+7�t+ Applicant Mailing Atldress <br /> C+1 <br /> y o� -��L l�r �t r��r Sr �� <br /> Describe Proposed Work _ <br /> W <br /> Prolect Adtlress(if known) 7 9�� ' ���'��'��� ��''�€S%�� l� � <br /> � <br /> Attach four(4�co0�es of plans for proposed work- Draw to scale and note Ihe following as applicable: � <br /> � • Properry lines • Centerline of sireet <br /> • Outline and dimensions of all existing and • Indicate Norih . <br /> p,,;Nc`�ed siructures on ihe bt • Show any proposed grading changes <br /> • Existing and prcposed utilities • Show measuremenis M <br /> W <br /> -'�� DO NOT WRITE BELOW THIS LINE O <br /> �� F <br /> _ �'i PERMITCONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8610. <br /> � . 2.q11 work shall be pedormetl in accordance with this permit and current City of Everett Design antl Construction <br /> i ��• Standartls and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.betore yo��dig.TOLL FREE NUMBER 1•800•424-5555. <br /> � <br /> I O <br /> � <br /> � � � <br /> � � <br /> ; ��, _ a <br /> _ � <br /> ,i ,� � <br /> Af;KNOWLEDGEMENT OF CONDITIONS <br /> ���� '_ �� The untlersigned owneVapp��cant hereby a9rees to hold and save harm- <br /> A — less the Ci1y of Everett from any and all claims �or tlamages, cosis. <br /> expenses. o� causes o( action that may arise because o� installation <br /> . �� �/� � // �� and mamtenance o� Ihe improvemen� or other righ�-of-way use hereto <br /> �?L'b�_ - applied tor and Wrther egrees �O ove bame UpOn nD�Ice Irom ihe <br /> Approved for Construcfion� Date Gity and to replace ublic'eroper ma9etl ihereby. <br /> / <br /> %�1.��-- S /7 5�v � / � pZ� ^ <br /> �� !' - <br /> FINAL INSPECTION Date y�p <br /> Approvetl as Constructetl Si nature o Applicant <br /> WORK AUTHORIZED BV THIS PEPMIT MUST BE STARTED W�THIN <br /> everett PUBLICWORKSDEPARTMENT tg0 DAVS OF DATE PERMIT IS ISSUED AND THEREAPTER iS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED 70 COMFLETION. THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BV THE CITV UFON ANV StOPF'AGt Uh WUNK UN tH15 <br /> Pbone:259-8810 PROJECT OVER 90 DA�S DURATION. <br />