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� ��—/� 1 [ � Vlldrk ePermit• � ��'O / <br /> Date <br /> Application For ��''-p� , � <br /> � PUBLIC WORKS PERMIT <��, ,,, ,, / '%,�Q3 0°°° <br /> ��y . . . . .iee�neo�'�ce <br /> qH Print or Type Only ea�.,��o o� s ZO <br /> � Htn <br /> � <br /> y �H S�t'c'.17�s �«r 4'7�5 C�P��, wva fUni�� ��� a�a 3/ly <br /> � y '� Owner Mailing AdAress City Zin Phone <br /> �N 'tl � <br /> H x� ��.erl e q j c[ �OU {� <br /> � p � Applicant Mailing Address Ciry Phone <br /> H ,f .o / I ' �J <br /> � � Describe Proposed Work � � I � � �G �U v l r� 1 c1 I�'� w�f � U V r � <br /> � �g . <br /> xH� o �, � s��P �� �e �� e�-� +� "; _�— — - � ,— - <br /> �i y �_in4 � _ _ _ 7 - . �J '--L+�r <br /> y y ihi <br /> M <br /> n G �r Projecl Address lil known) ���'�� �7 % Q���� � <br /> �t�� [�1 <br /> Attach lour(4)copies ol plans br pwposetl work- Draw lo scale and note Ihe wing as applicable: � <br /> �y • Property Lines • erline ol streel ♦A <br /> • Outline and tlimensions ol all existinq and icate North V� <br /> � ProPosed struclures on the lot how any proPosed gradinc�chanc�es <br /> • Existing and proposed utilities Show measurements � <br /> DO NOT WHITE W THIS LINE <br /> 1 PERMIT CONDITIONS O <br /> 1.All calls for inspeclion shall 6e made 24 hrs.in ad -phone 259•881�. <br /> � � 2.All work shall be pedormed in accordance with rmit and current City ol Everett Design and Construction � <br /> • Standards and Specilications. <br /> 3.Call Localion Underground Service 48 hrs.b you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> I ��! �• /2GC/C w�c �� '�u l�c� 7�e.cl t��fS,c�e c���e�-.5e�✓/� O <br /> ' ��of �-�s.i �6��w ' nv�-!h a-�-f/� s.;�-1h f:���,�-fi� /, Lc c <br /> i �� o�� � 1. �� X �i'��if�� ��/ /,�rc �•- �`�-�1 `�''wc /'�*�a/-,�,, f') r <br /> / � <br /> I��� S �'oc4�v J �tc� // co-� -�r.y 7'� G.'� a���-✓c�f s�c/ 0 <br /> J'��t h 3Z�f , a <br /> I�I�i. ^` n 7 ,,�, <br /> 4 , /�� �1'� ,/J /< <'� ���G � ` —�ACKNOWLEDGEMENT OF CONDITIONS <br /> ! <br /> The undersignetl owner/appliwnl hereby a9�ee5 to hold and save harm� <br /> less the Cdy of Everett Irom any and all claims lor damages. costs, <br /> � � � ��� ezpenses, or causes of aclion �hat may arise because ol installation <br /> / //�� �� and maintenance of Ihe improvemenl or other righlroFway use hereto <br /> G apP!icd lor and lurther ac�rees to remove same upon notice Irom Ihe <br /> Approved for Con, ion Date City and to repla �puUlic propert�damaged thereby. <br /> / \, <br /> FINAI INSP ON Date /��'��/� ��2��/ _— - �/`" � �Q <br /> ApP�oved. nstructed ign ule ol Applicant Oale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> � PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLV PURSUED TO COMPLETION. THIS PcRMIT MAY BE <br /> Everett,WA 98201 CAi:CELLED BY THE GTY UPON ANY STOPPAGE OF VJORK ON THIS <br /> Phonc:259�8810 PROJECT OVER 90 DAYS DURATION. <br />