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1 <br /> � � ,� -1 f/'R z- ' yS_3 , / <br /> � ( PuOiic Woiks Permlt• <br /> � • Date �� `'' <br /> � Application For Td POSTI NGT— eioA oaa�.+ <br /> �n <br /> �yy `T WORKS PERMIT <br /> PWiitYloiMeFee g <br /> PU B'LI C To,a�Faa <br /> « Less ADCI.Fae PaiJ $ <br /> y �I o � <br /> f� � _-� Dalancc Oue g <br /> �� � n�, c; rn <br /> H '�:nt or Type Onty�, �- `'! /i[ b z S <br /> �. c. •f, �, 7 <br /> fA� �v n� r.� .;�. <br /> �� u: ,- —, <br /> � �vu,e.�1" I L�'z.0 :Sl�onv�k� C�n�kc1 �.�i��e,�,a-��p lllvo IJ(-. `�'r1� �- � I � `Is�l'ISz-5 <br /> ��� Owner ��,' '' in c� n �-M iNng Address ity Zip hone <br /> ��, o c� .-r.. ci <br /> p O ' �y -7 (' i� 5 ^� ` I <br /> IQ-�� � �� \C�2V1f��S CC;� u �` �JO (�� L��lY�� lPcaSl"\��'- r.7�� � !� �-�IZ I��'� <br /> �y� Applicant Mailing Address Cily 2ip Phone <br /> y �` p <br /> . M-H <br /> �� Describe Proposed Work � �-U 4�G l�0 V'�tn �r�.k.�Cti��— '�� 7 ��S-�n''� S V p YJ �eFYI P V..�1 G� <br /> N r` 1 <br /> ��+ �''� (1Y1N1 r�A t-�I�- -Y[UC 1 � I�IP � �'(�ItiS (� FI Nq (�I' "�"� Ve-� ''��/ 1TO _ <br /> �OC4 �` ('n }'C1n �'x � 1�i5 CO��NCC�(r3. -�a 1, � < �lW ('r,.- 1n S� �\S <br /> u '�1 0. �� G Se�lle. C. � <br /> ._ 53-0 C, t'_�f�1 � � <br /> Project Address(if known) <br /> Attach four(4)copies ol plans for proposed work- Draw lo sc�le and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol street ♦� <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /�/� <br /> W <br /> ' 00 NOT WRITE BELOW THIS LINE O <br /> � ; <br /> r PERMIT CONDITIONS <br /> , ��� 1.All calls for Inspeclion shall be made 24 hrs.in advance-phone 259•8810. � <br /> i i 2.All work shall be pedormed in accordance with this permit and current City of Everelt Design and Construction <br /> � ! Standards and Specifications. <br /> i �_ , 3.Call Location Underground Service 48 hrs.b�7ore you difl.TOLL FREE NUMBER 1-800•424•5555. � <br /> ' ' � ,Q-� a��-��� �� � <br /> � --� � ��� � l� d�... ,� ' <br /> ; c�� ����« w�� �ix,��Z�� �, ���-2 -�r 0 <br /> I _.s �c�� �ru�,ck-.�� �" <br /> �� � <br /> I '_1- � � <br /> , �_ <br /> a <br /> � <br /> __ <br /> � AG<NOWLEDGEMENT OF CONDITIONS I <br /> ' The undersigned owner/applicant hereby agrees to hold and save harm- I <br /> less the City ol Everett Irom any and all claims tor damages, costs, <br /> 1�� expenses, or causes of action that may arise because of installation <br /> � � �.�r��� and maintenance o1 lhe improvement or other ri9ht�o1-way use hereto � <br /> � �- � ����"�""� - app�ied tor and lurlher a9rees lo remove same upon notice from the � <br /> Approved for onstru�tlon ���e City and lo replace public property damaged thereby. . <br /> i <br /> / ' 3 <br /> i � I / � `// <br /> �6 �. �L3 � oate I % C-ll C. �� .{/����t�' / , - <br /> FINA INSFEOTIO� � - ;� �� 1 � V Date <br /> Approved as Construc�ed Sig aWre ol Applicant C. l 1 5�,.����CGL�LL� , <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAfiTEO WITHIN <br /> ���� PUBLICWOFKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEPEAFTER IS TO <br /> ���I 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MP.Y BE <br /> �T Everett,WA 98201 CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS � <br /> Phone:259-8810 pROJECT OVER 90 DAYS DURATION. <br /> — _ :':a:,,}ut <br /> � <br />