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_ � `�/ Pu�LCWorkaPeimRs • / ���� II <br /> Date . e�aa oao� . � <br /> Application For <br /> WORKS PERMtT PublicWorksFae s` ; <br /> PU B LI C Tolrl FeP <br /> less RDo�Fee Pz'd S ��� <br /> J <br /> Balance Oue <br /> Print or Type Only- � � OOG—j2 Z- S�O—OIYJ -/cg —,33/ <br /> T' v��f,��` 1���='y �3 �3 37da <br /> I/ �J <br /> F�� � ' d ���.._: �n ��-�- ?� / � Phone <br /> Owner � � � • '-'�. Mailing Address <br /> City Zip <br /> ��:, �J. • <br /> � �l Lv� � -�� ��t'/{i / / <br /> /'cc�v.�-�' ,_; . . C�ry Zip Pt�one <br /> p��plicant <br /> Mailing Address <br /> .� �� �/� � � �s% I <br /> Describe P osed Work , `, „ �, �N '� <br /> � j�,�, �, . 'c�-.r.�� t� i <br /> �/!L .���,• c . <br /> � W <br /> ------ I �� LZ �✓�/� /`P2n 4y � <br /> Project Address(il known) � <br /> Auach four(4) copies of plans lor proposed work- Draw to scale and note�Cenite Gne ot street able: � <br /> • Properly Lines • Indicale North <br /> • Outline and dimensions of all existing and � Show any proDosed grading changes <br /> proposed strucWres on the lot � ghow measurements M <br /> • Existing and proposed utilities W <br /> DO NOT WRITE BELObV THIS LINE O , <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•SS10. <br /> 2.All work�hall be performed in accordance with this permit and current City o(EvereU Design and Construclion <br /> Standards and Specil'.cations. �. � <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800'424-55 y ,�r_ <br /> r�.<.: cc>�frc� <br /> �/ �'�:.; .. � i, ..��✓ �y �i� <br /> Sf'�.-, t ��•�-L �r= ��.1_Y%-z`�-�,��.�- , Cl-; <br /> �f �'.c�' C'.cl�/ Ci��/�)�tUL l.t.';':'�f <br /> '/ �' e9 <br /> ��' .-3'L<,��.y1--�<.�' , /nSr���[1c1". <br /> �/a<:L j 0 . _" � <br /> � � /�('��«�=^.-c4f� �o��.�C'F� G-z !/m,_./ 5:�� �� <br /> J Q/fl[ m �/ ZI f ' � � <br /> � 2�1-c�z,tc..� ��l��rr�'2Zf:e., _.C�'c�l��� /1lcc�i Gc��C"v :�?�(r�.`/.,� <br /> 72r_f � �,.,��,e�. � 4 O <br /> / , / '� <br /> / � �izr;__ ,�zc��ik !1�Q�c�, �/[ll� <br /> (�. �G''7�zr-L...� lI�CG._�O � S['� � /-" � L' <br /> — caNs;,��� �-T-��r✓ 0' <br /> �,tjj /l�is is �c2� fI /�',�'�,-��T .�i�v Aoi�,,�,vi✓e�i�c,r�rT <br /> ��F ,�I PfI,c�C/�, ir LaT-- . <br /> • o � �z�ilC f� ��'Cl�G�i.C'�J F iC' f��✓S/ <br /> ND� iC' Cs�A :'I �i r_Fz c <br /> ) S - ACKNOWLEDGEMENT OF CONDITIONS <br /> �/ ,� �TyE",�' T//Fi�/ f'l�l�/r��; JT/LL . <br /> i �„ (��(' Tiie undersigned owner/applicant hereby a9rees to hold and save harm� <br /> '1 less the City ol Everetl from any and all claims for damages. costs. <br /> � �� ezpenses, or causes of action that may a�ise because of installation <br /> :��;� __�� ;/ <br /> and maintenance of the improvement or othei riyht-obway use ere o <br /> .%�'� ''�� �='�.�'�_ aPPlied for and further agrees to remove same uPon notice irom the <br /> Date City and to replace lic property damaged thereby. <br /> ApProved (o.L�6�sk�ti9r[ �� � , <br /> � / / 7 <br /> /" �C � L � <br /> �/ ./�� Date � <br /> Date <br /> FI AL I SPECTI AL l i ure ot APPlicant <br /> Approved as Constructed �ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �-7 PUBLIC WORKS DEPARTMENT ��DI�LIGENOTLY�PURSUED TOICOMPLEDION.DTH SEPERMIT M Y Bfi <br /> 'v�� 3200 Cedar Street <br /> EvereU,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI <br /> Phore:259-0810 PROJECT OVER 90 DAYS D'JRATION. <br />