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�� � <br /> �.s� <br /> ' �� <br /> �5 @ <br /> , � <br /> , .:x ---- — -- <br /> � <br /> __ _— ---- <br /> � ��._._ __—_'__'—__—'__ ._ __r . . __�___'__ . .n�.. . . . . � . <br /> �I � �� Pu01¢Wo�Ms Parmil� <br /> Date � 8 q 90/25315 <br /> aiee o�n��� <br /> Application For <br /> n PUBUC WORKS PERMIT PuLLCWa�hslea S <br /> Total Fee <br /> ��y Less Appl Fee Palcl g _ -- � <br /> y eainncc Ouc S__ <br /> C;vN Print or Type Only <br /> >HN <br /> ~ �� H111 liuqh�i6 8112 P10Iidd Dr EveTett 9a203 779524� <br /> � y� Owner MailingAddress Cily l.ip Phone <br /> �y V7 N 04R18L' � <br /> 5 x� qpplicant MailingAddress City Zip Phone <br /> L+7 O L� <br /> H <br /> OH <br /> N �g DescribeProposedWork CnSDort --� <br /> Q� n I <br /> zy� — - <br /> � �H W <br /> y <br /> � 8112 FlOLlda Dr. � <br /> (] Cy VJ Project Address(if known) -- <br /> � C� Attach tour(4)copies of plans for proposed work-Draw to scale and note the following as applicable: � <br /> y VJ • Property Lines • Cenlerline ol street ♦A <br /> �7 0 y • Oulline and dimensions of all existing and • Indicate North V� <br /> � proposed slructures on Ihe lol • Show any proposed grading changes <br /> ' • Show measurements /1A <br /> '' • ExiS�ing and proposed utili�ies � <br /> ; DO NOT WRITE BELOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> i.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> �'� 2.All work shall be peAormed in accordance with ihis permit and current City ol Everett�esign and Construction <br /> ��� Standards end Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE�UMBER 1•800-424•5555. � <br /> 'w � <br /> � � <br /> �U��r. lrJa�,�� �/�+r.��.-f /LA.�/'._cf �,z_� �/� <br /> � y ar•� ,. , i <br /> �.� � f ��n/cf% - V♦ <br /> ./��J`—'/ O <br /> _�_ a <br /> ,_,_ � <br /> _ I ,) ACKNOWLEDGEMENT OF CONDITIONS <br /> �'_ fj��/ The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ci�y ol Everetl from any and all claims lor damages, wsts. I <br /> i expenses, or causes of action that may arise because ot installation <br /> I and mainlenance of the improv?meni or other righbof-way use hereto <br /> �� I <br /> applied tor and turiher agrees to remove same upon notice rom t e <br /> Approved for Construction Date City and to replace public properry camaged thereby. <br /> FINAL INSP[CTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTHORIZED BY THIS PER�71T MUST BE STARTED WITHIN � <br /> everett PUBLICWORKSDEPAR7MENT 780 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> � 3200CedarStreet BE DILIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet�,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•BB10 PROJECT OVER 90 DAYS DURATION. — <br /> - --------- - f <br /> ; <br />