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, <br /> � ' <br /> - - � , � <br /> ; <br /> �at ,E/�'_ . Puhlir Works Permit• <br /> B�dp Oeo��• ` <br /> , � � Application For ' <br /> PUBLIC WORKS PERMIT °°`�TOWFe�`"° s <br /> . less eoDl.ine Vain 5 . <br /> : . • s,ia�..,o��� S B`JS--o <br /> Print or Type Only <br /> ��S�inr,V�Ww �c�zZ }�w�9�i �tsx.tsl� �' 353-3� <br /> Owner \Qa�nny ::dreSs Cq) LP Phone <br /> �n) �lV� rl�L�����1— �t.b�j____�����__ 3�3��oD _ <br /> Applicant PA;,�lin:; :iddre;s Citv Zip Phone <br /> .Descri6e Proposed V.'ork _ -{�-��^�-�-1-��1`-w� ����-�"T'r'` �'`-� <br /> ���� r� oQt-s4-_.D_�t_�-��s-. t�_- - <br /> -F CiO�Yos $cu_ ------ --- ------- — <br /> � W, - - - -- ---- <br /> ' ,Prolecl Atldress 1�1 knnwn! �0�z--E✓�L.r J-v�-"'-�3-v�-Wal/-----' � <br /> � Attach fo�r 141 coG�es ot Plans to� propused worti � Ilra�� t-, �cal.. ,c•., ncte �h/'citc�a�ng as aoul�cah�et. . . . .. .- � � <br /> ' • Propeny Lines • C�an�eiline nt strP rt ..�,\.,�_::.�. . � . <br /> • Outline acd dimensions ol aP existinn and • I.^Cicab� Norih � �- - - � <br /> � proposed structures on tl�e loi • �nov:any r.rcposed grad�n�r.hanyes ��� <br /> . � � • Existing and proposed utilities • Shov: measurements . �" � � <br /> - � DO NOT WFITE 6LLOW iH15 LINE O . <br /> PERMIT CONDITIONS <br /> � 1.All calls for inspection shall oe made 24 hrs.in advance•phone 259•8810. � � <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br /> � Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � � <br /> ¢ C4�7$frr/cf ..Si���� TanCz 410�� L✓2J'7� S�o�� O <br /> �' c�or,E a.-� a �s �i�cfe� 6y �/�e cify <br /> P!/�)L/G Cdor�',s' �/7.j�,jCCfo/-; H <br /> ✓� rX�Jt/'�-P�C /2lrJ�� C�CT�tt�-�p.-.. �4�a��u�.f� �1�✓ � <br /> C'c�-t�/ �-�u� 208. � O . <br /> �s. .Se¢� �'�PaSG� LG �f/, ccrc� (,t,���i�� �SC�ayS � <br /> � (7� CO<.1/��.e�/ns LJUP'F- <br /> / 1 <br /> �, / ��Je� Sfi^E6�J CLe��� �T �(�L J��'7�, ACKNOWLFDGEPAENTOFCONDITIONS <br /> � 1 he undereiqned ownci�aPpi�cxnt hereby agrees to hold and save harm� <br /> �� ---- "-�---� lass ;he Gity ot Everet� irom any antl all claims tor damages, costs. <br /> �� ��. / � e.pensr.s. or causes of adion that may aris= because oF installation <br /> / �� anA ma�ntenance n! ihe improvement or other ri�lhbofavay use hereto <br /> � 1 � �g�1? � ,�opt�n;; for and further a9rees lo remove same upon notice from �he <br /> ? <br /> prov or Co� tio , ���<' � .. � .n rep. a publ�c pronerty damaged thereby. <br /> r 1 — � 6 � 1 , 231� <br /> . FINAL I ECTION L ��1e Da�e <br /> A p p�o v e d a s C o n s t r u d e d Sign� re ol ApGlicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE�STARTED WITHIN <br /> ' ������ PUBLICWORKSDEPARTMENT 7H0 DAYS OP DATE PERMIT IS ISSUED AND THEREAFTEii IS TO <br /> � 3200 CedarSireet � I BE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � � Everett WA�38201 CF,NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ThiIS <br /> `1 � Phone:259-8810 � PFO.IECT OVER 90 DAYS DURATION. . <br /> �. � � . .. . .. <br />