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, <br /> i <br /> I <br /> ��� r, �'-�`� �1�'i '�i;; i,r�• c . <br /> p ��� _��` � ��necwaxsae�mu. ����� <br /> H�� Dale-1�.��� �j ��h._I�� oma.o�n�.,_� -�' -,�--- . <br /> M npplication For 1 <br /> ��� PUBLIC WARKS PERMIT P°°'","°""`- <br /> Tolnl F.�v S— <br /> ' Le55Ap01 FeePni� S _�'��O <br /> A Balanca Duc S <br /> ��C� Print cr Type Only ppZ-,jzz-Yo -G�o_//-�3/ <br /> �� � ; ��� > >y co s� �� s-�- �i I�l��ce ��� �, <br /> Q• O i- n��-�".`�"_ Cn L Phone � <br /> H g Owner Mailin9 Atltlress Y P , <br /> rHH <br /> H� <br /> �M Applicant Mailing Atldress City 2ip Phone � <br /> a G ,�/��� � � I <br /> W� ��i� ������ � <br /> Desc�ibe Proposed Work <br /> O(� <br /> _ .. W <br /> Pmlr,cl Addres51i1 known) ��� �� � �-���v-=�'� � <br /> Allach tour(Q)copies of Plans�or proposed work- Draw to scale and note the tollovring as applica6le: � <br /> • Property Lines • Centerline ol street ♦A <br /> � • Outline and dimensions ol all ezisting�nd • Indicate North V� <br /> � propnsea structures on the lot • Show any proposed grading changes <br /> �'�� • Existing and proposed utilities • Show measuroinents M <br /> � ��: � ' DO NOT WRITE BELOW THIS LWE W � <br /> , O I <br /> j � PERMITCON�ITIONS <br /> i '__ 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � � <br /> 2.All work shall be performed in accordance with this permit and current Ci1y oi Everett Design and Consiruction <br /> , •wn.�,� Standards and Specilications. . <br /> i , 3.Call Location Underground Service 48 hrs.before you dir TOLL FREE NUMBER 1•800•424•5555. � j <br /> I <br /> �`�, S'.G� CG�`'�(.o �o �e �r.,�-fa'-�°c� �eii a��toz�-E'd� O <br /> i �s`� ,J'��� �/� /�� -�S' ., ��T/F�Cf/£O> <br /> r- � � <br /> , 1��j � � <br /> �� �e <br /> � <br /> ' I�j � <br /> v <br /> I <br /> I 'O � ACKNOWLEDGEMENT OF CONDITIONS <br /> I � � <br /> � The untlersigned ownedapplicant hereby agrees to hold and save harm- <br /> � less the Cily ol Everett trom any and all claims lor tlama9es, costs, <br /> expenses, or causes of action ihat may arise hecause ol installation <br /> // �_8B and maintenance ol the improvement or olher right-ol�way use hereto <br /> �� applied for an rthe gr es lo �emove same upon notice Irom the <br /> Approved� ons rucfo , .. ^ Date City and 7e " uhty,property damaged Ihereby. , <br /> �' / / ssc uoP�dn.4c�e0N <br /> � �������1-%7���——'-������— ✓ i�_ > y'�f,.✓T .ti � �✓�v�� � <br /> FINA INSPECTION ��G� Date . <br /> Approved as Construcled SignaWr f-Appli , Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN . <br /> everell PUOLICWORKSDEPARTMENT 180 DAYS OF �AIE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200GedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE ' <br /> Everett.WA98201 CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> I � <br />