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�.��0'y� . <br /> C�M ��� ��� �S� ✓ <br /> ��� Date�J I v��m��wo.xaPe,m �/����� <br /> ���� PUBLIC WORKS PERMIT � ,���� ,���� <br /> Appllcalion For eiee <br /> �O . --_—_-_______...__.. <br /> Vubli[�Works Fee <br /> �alFee $-- --- <br /> fA M <br /> �essa�,ni neeae�� S <br /> ��� aa�T��r o�N s��� _ <br /> d Print or Type Only <br /> O�+ <br /> ��g <br /> Q` � l�Y�� �-" �'�K)� �C�'i��R ��� /-�1J� S� l.( �'Y1��i'�� il I!P <br /> x y� Owner Mad�ng Adtlress City Zip Phone <br /> � �38U� �9,(r �� <br /> .. HH <br /> � <br /> �"� qpphcant Mailing Atltlress City Lp � Phone <br /> (�C7 fA <br /> �c� ��� e�� �S �!k �or��__�) <br /> y�y� Descrlbe Proposed Work � [ <br /> HO�a <br /> Proiect Address 1if knownl 7���� - <!Jl�'7�C,f' FL:E ES7'� ��V � � <br /> Attach four�4)copies of plans for proposetl work- Draw ro scale and note the follo.ring as applicdola: � <br /> • Property Lines • Centedine of street � <br /> • Outline and dimensions of all existin9 antl • Indicate North <br /> proposetl structures on the lot • Show any proposed 9rading changes <br /> • Existing antl proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> � PERMITCONDITiONS <br /> ���� 1.All calls for inspeciion shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br /> �� Stantlartls and Specifications. <br /> 1 ' 3.Call Location Underground Service 48 hrs.before you tlig TOLL FREE NUMBER 1-SOO•424-5555. <br /> C� � ��� �.�.u.�«� � �� �.�.f �� �O <br /> .�, .,e.�.� .-� -�.�-� ,o�o,�o-zea a/�,,� . <br /> + ��. �xo�� Pa��°ror��'hec� c�.c-rrecva �C'c..� �� � <br /> �ei�. �c.�y .L'�¢��.�2� '#307 a�.��ra7�or✓ .�.3 7 . � � <br /> /1 O �/ <br /> �_ icO�JrrazfC .C�2cr2��l��odt-fo>✓>✓ �,�cc6�.�.,q Ct vt.`i-Gu.� � O <br /> 2C�a�222(. L�.� � ��� �'�/oL'c-�cGv� • 1� <br /> ��� <br /> �� <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> �� The unCersigned owner/applicant hereby agrees to holtl antl save harm- <br /> r� less the City of Everett from any and all claims for tlama9es, costs, <br /> ` � expenses or causes o� action that may a�ise because of installation <br /> J �,/ 9 and maintenance of ihe improvement or other righbobway use herpto <br /> -� � � L appli for antl furiher agrees to remove same upon nohce from the <br /> APP�ovetl tor Con uCfion Da�e Cit ntl to re laCe publiG roper� tlam <br /> y p p y ged thereby. <br /> � � �v-. � �6y � �� �C� <br /> FINAL INSFECTION D'ate �'�'�' <br /> Approved as Consfructed iynature ol Applicant Da�e <br /> everett PUBLIC WORKS DEPAFTMENT N�ORK AU7HORIZEO BV 7HIS ?ERMIT MUST BE STARTED WITHIN <br /> O 3200CedarStreet 180 DAYS OF DAic PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 9A201 BF. DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone'.259-8810 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON rHIS <br /> PROJECT OVER 90 DAYS DURATIpN. <br />