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I �. <br /> � <br /> � <br /> � <br /> ��� Dat�� c�m��wo,.�a���, iJ�-f��-I R/ — �� <br /> 6in:� Depi + _f�—J_/��— <br /> p � Application For — <br /> � � PUBLIC W�DRKS PERMIT V°°'�°w°�YSFeB S <br /> iolal Fee <br /> y � les.Anoi Gee�a�a 5 <br /> K A eaianccouc 5 ✓-�-��� <br /> o p� � Print or Type Only <br /> �I <br /> W <br /> ��� ,�;{9r_i!J(= Sc/FP� '� ! /'�°R-r�- Cp /3/� l21;�_ �� c�'6rcii (;t�� 07��'. '3�`11 <br /> O� p �W�e� Mailing Atltlress (.�ty Zip Phone <br /> H00 ' � E✓C/.'-i=!t�L:J /.,�n �- ��.. ...:�i� nJ'�.,�i° ..�-+,J� - �':7: <br /> �. ��,��.�Tj JyRcF�r[!� �N�P ��E�/< <br /> �„� Apphcant Mailing Address Gty Lp Phone <br /> .�iy � �; ��, �� �, . i� <br /> F+ / '�� I�U:..0 �l_ � AiJf; /?7n^�/c.:� TT�t- c_c.� / J ct/ . <br /> �� Describe PropoSed Work Ll' � �"/ � <br /> �.y�p /�'j' �'!(jl�/' r %177 �r'U✓��Y' i,/��'.`T /PJCL (/(�/ P✓ C.. �r/ 1�/ /L?1.., ' , <br /> �W <br /> �� W <br /> � � <br /> _ � r �� i � P 2�<�;> J�l� ;' '"d,'/'�Ti �'�'.: C,� H I <br /> Proiect Adtlress(il known) �� �� `'�' �", <br /> � <br /> Attach lour�4) copies o�Plans for proposed work- Draw to scale and note the followiug as applica6le: � I <br /> • Property Lines • Cenledine.of street /A <br /> • Out6ne and dimensions ol all existing and • Intlicale North V� I <br /> proDosetl slructures on Ihe lol • Show any proposed grading changes � <br /> • Ezisting and proposed utililies • Show mezsurements �A ' <br /> W " <br /> � � DO NOT WRITE BELOW THIS LINE O <br /> � � PERMITCONDITIONS <br /> ( �,; 7.All calls lor inspection shall be made 24 hrs.in advance-pnone 259•8810. � <br /> � 2,All work shall be perlormed in accordance with lhis permil and currenl Cily of Cveretl Design and Construc;ion <br /> � f ` Slandards and Specifications. <br /> 1 3.Call Location Unelerground Service 48 hrs.6efore you dig TOLL FREE NUMBER 1•500-424-5555. � <br /> �-- / <br /> I __� y � , <br /> �f'CC, CJ�'` ..2'c � cYc.�-�� �C>.t 2r/.?cz-�A �.y O <br /> �' _/ -c_,. �r— / / ;' C�r'/ 'l ���lr_��r✓ <br /> C°(_G..[.� C�"/�ILtJ � ��lt-COl� J -•��'-�J � <br /> i �� ♦�^ II <br /> Y/ <br /> , _ � <br /> ! -'- a <br /> ', !1�� <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> , 7he undcrsigned owner/applicant herehy a9rees to hold and save hann� <br /> �=1=� less Oie City of Everett Irom any and all claims lor damages, costs ' <br /> ""��/l exUenses, o� causes oi aclion that may arise because ol inslallalion <br /> / /5_ L�, /_�+ _��7 and mainlerance ol the improvement o� other right-o(-way use hereto . <br /> �- :> !7/L�+"f''" !i � I <br /> anni�c lor and furlher . �ees to remove same upon nolice Irom Ihe I <br /> Approved lor Co istr c)ion ���e Cily id to replace pu i propert dama�ed ihereby. <br /> I <br /> ��j�.�_ . /� Slo / � / [� 3�/�' <br /> FINAL INSPECTION Date <br /> Approved as Constructed Si9nalur� ol Applicant Date <br /> WOfiK AUTHORIZED BY THIS PERMIT MUST BE START[D WITHIN <br /> everett PUBLICWORKSDEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV' BE <br /> Everet6 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc:259�8810 PROJECT OV[R 90 DAYS DURATION. <br />