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, <br /> , , I <br /> 7ate�� n,�oi��wo,ws a�, � <br /> ,5`'�� <br /> AppliC3tion Fot �I�9 Oeo�.• � <br /> PUBLIC WORKS P�RMIT P°°��°~'°«SFCe <br /> ,o���F�� g_ <br /> iess nnoi.Frte an�a 5 <br /> L� <br /> eawoceoue 5 .�� <br /> Print or Type Only <br /> � ( / �!I / l <br /> (� YNPJV' � J7dKQ.. �tv+� OM�{� / V'U J�n'/�l�i � �lG� <br /> Owner 3 Jp(� Sf st�/ W�Mailing Atldress Li��Q City Zp Phnne <br /> k3z.a3 �a� --a3y� <br /> ScwK.e., -- <br /> AppGcant Idailing AdAress City Lp Phone <br /> I 1\ � T �P �5�� Q-�'ra'f�P �� <br /> Describe Proposed Work p L<P�it '(ir 'h:�10� m^ F.O,w 0 �Tf' <br /> l.F )�1 � _ <br /> C(7'e l) . i-/ /��. .: "\�f'��. <br /> [f� �� /� /� �(.,� W <br /> Prolect Adtlress Ot knownl _j J I�o (�"/Q ti A��rn i� ' '"�' � <br /> Attach low(4)copies ol plans for proposed work- Draw to sca�e and note the tollowiny as applicable: � <br /> • Properly Lines • CenterGne ol streel � <br /> • Outline and dimensions ol all existing and • Indicale Norih <br /> proposed structures on Ihe lol • Show any proposed gradin. �hanges <br /> • cxisling and proposed utililies • Show measuremen�s � <br /> DO NOT WRITE uELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.AII calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Cons;ruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � �2.CC-YtdC� --�� �L.0 � .�i�2C�e°� -�c��Y l�� !GJ-���E-!� � <br /> r <br /> � , <br /> 2 �., -7�rci,.u,�wr� � �.���.a� �/�' Cz�4-z �d4��C�c_�o%E�•�f�C',��, � , <br /> •> ��L�c�.�-L �DJ �)�zc�� ;�✓ .� �!�-'C�> �O'2P- �c'1J2?�!-�c'./�i7,: � <br /> �J�lk'c,ic-�+�j LcIL�/�' �'i�C�cfi l�%07/'�1- .-l.p.�j�'-?�6'L �1� /_�'7�. O <br /> - .�..� � � � � <br /> .L"l�-1./�,�Li..:.,r. J�L�C: ..�ClC,tiC :7iy_ <br /> � <br /> I <br /> hCKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> — ��� � � less the City of Everett from any and ail claims lor damages, costs. <br /> � � expenses. or causes ol action that m2y arise because of installation <br /> / � <� /�� � r_, �, �/ /, n/, and mainlenance ol the improvement or other right-obway use hereto <br /> + ' < <� �����-��� � � � applied lor and iwlher agre �s to remove same upon nolice iwm the <br /> r ved lor Const�lion ate City and to replace public p..rry a age ereby <br /> �'��� � -��"s'� � � <br /> FlNAL I SPFCTION Dale ' '�-g <br /> Appioved as Constructed Signa ure pplicant I/ � Date <br /> WORK AUTHORIZED BY THIS PERMIT MUS BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILiGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone;259�8810 PROJECT OVER 90 DAYS DURATION. <br /> I <br /> I' <br /> � <br />