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� �� „ . � <br /> � -.c�vo.�.re�m_�L.� _ � <br /> � Date v`, ��.�^�_ j'�t <br /> cia:i o�.ai . __,�.�.1==��i��1J <br /> � � b Application.'or _ f __ <br /> � � PUBLiC WORKS PERM17 P°°roWF��'"� 5 — <br /> �' � N �essnoo�.Fee aa�e 5 — <br /> ys o.,i,��ao�� 5 <br /> K Print or Type Only <br /> o � o <br /> ro y N <br /> � ¢ -�,�' a� - r�.�����,�� � �.�_n� _ <br /> p � �p wn� Ma ngPddress City Zip Phone <br /> M [qR <br /> G1 • <br /> b y � Applicant Mailing Address City -'�r �'������' <br /> t^ <br /> C N — <br /> " l'�1�4�1L�`_ <br /> f� � <br /> (a Op N Describe Proposed Woik _ T <br /> � M r�p . <br /> O N <br /> W <br /> Proiect Atltliec:lit 4nownl — n�� � � — � <br /> Atlach four(4)copies o�P�ans br proposetl work- Draw to scale and nole Ihe lollowing as apP�icable: � <br /> • Property Lines • CeMedine ol street /A <br /> • Ouiline nnd dime^aions ol all existing ard • Inditate Norih w� <br /> propos?u structures on ihe lot • Show any pmposeC yrading changes <br /> � E��..S(inc7 and proPoSed utlities • Show meaSuremenls /y� <br /> ��'m�� � �-���`�r� DO NOT WRITE L'ELOW THIS LINE � <br /> PGHMITCON4ITIONS � <br /> 1.All calls lor inspc�tion shall be made 24 hrs.in advance•ph�ne 259•$810. �1� <br /> j�r�v ?.All work shall be pedormed in accordance with this permit and currenl Ciry ol Everett Desipn and Construction ♦ <br /> � `_� � Slandards and Specifications. <br /> , 3.Call Location Underground Servic�48 hrs.befere you di9.TOLL FREE NUMBER 1•800•424•5555. � <br /> � __ . � <br /> � ! � ' � / ��,%�rJ��f� . � Q�`J—�� <br /> �� CG07/�t� �.��J�ox,�,(� ru,C- C%)_e <br /> ' /.-�,c-C4"« x �--��:/ � <br /> I � � � <br /> �� <br /> 0 <br /> �� 1 a <br /> . �� <br /> � o' 1 . ACKNOWLEDGEMENT OF CONDITIONS <br /> � <br /> The undersigned owneqapplicant heieby a9rees to hold and save harm� <br /> . less the City of Everett Irom any and all claims lor damayes, costs. <br /> expenses, or causes ol aclion that may arise because ol inslallation <br /> � and maintenance ol �he improvement or other nc�hbo��way use hereto <br /> ��. __ app�md for and lurther apmes �o remoce same upon nolice Irom the <br /> Appwvetl lor Consiruction Date C�ty nnd to replice puhlic property damaged thereby. <br /> FINAL INSPECTION Date -- <br /> Approvetl as Construcled Si9natwo of ApPhc�nt Date <br /> WORK AUTHORIZGD BY 1'iIS PERMR MUST BE STARTED WITHIN <br /> eve�rtt PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUEC AND 7HEREAF7ER IS 70 <br /> � 3200CedarSlreet B[ DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc:259�8810 PROJECT OVER 90 DAYS DURATION. <br />