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� <br /> Gate�� 70 POSTING �-3J�� 5' �ObLCNO�hsPn ,�. %J'�} `�'�'���`� /' <br /> �iny oea�.. .��-�J_�_-- <br /> ApPlicatinn For <br /> PUBLIC WORK� PERMIT r°`rowF��"° S ----- <br /> Less Ano� Poe Paia S_T <br /> 9a�an<r Dun S 2c� � • <br /> Print or Type Only — <br /> �1��- —S� �w.r cu..Q �t�er�-��ar�1 ac' <br /> 3�� s� S+ �� w ����.�_ �R�-3 a58'�`3�l`1 <br /> Owner Maihng AddreSs Cily Lp Phone <br /> Sa',wi� - <br /> ApplicaM Mailing Address City Zip Phone <br /> Describe Proposed Work �� �+� '� S ��f� �'�'� ��� '�"�� � �?� �T�f`� �� <br /> .h� ".1 <br /> C'm:.:I z 1' �' r =��'�' W <br /> Proiect Pddress lit known) -- — �1 010 (�� w- , �-, � <br /> Attach four(4) copies of plans for propo5ed work• Draw to scale and note the following as apVllcable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all e■isting and • Indicate North <br /> proposed structures on tha Io1 • Show any proposed grading changes <br /> • Existing and proposad utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be ma.ie 24 hrs.in advance-phone 259-8810. � <br /> - ` 2.All work shell be performed in acwraance with this permit and current City or Cverett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Locatio�Underground Service 48 hrs.before you dig.TOLL FR'cE NUMBER 1•800•424-5555. � <br /> 7 �/ O <br /> , L?.���<.-2� f� ,� �x f�«�_u. �� �r,� « ������'f� <br /> i '� _ �,' +� � ssccLL L/ ,�!; / / <br /> ,�y .�h't.�.�Gr".Cc�/-r�/ �7 C�jCca-Z a� O`L�v !��(f � �<a�4-N���LS"C/i <br /> / p // � <br /> Ja-�C�Gc�-�'� ( ��27�^,[CI-i/ .Co �Co .1-C%�,lt�is ���— �'OJz.2�c�nl ch�' � <br /> ��2e�n�, lc/L�i�/-�.�'-C.'c,C� ltl��2 �L�'+:1�.a'C�1[�'Z. �.l�:''2G � <br /> �/1J-12�����,� �LC�c.. S�Cc���7.2 - � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> .I The undersigned owner/applicant hereUy agrees to hold and savE harm• <br /> less the Ciry of Everett trom any and all claims tor damages, costs, <br /> � / � expenses, or causes ol action that may arise because of installation <br /> / J � /! �5�� and maintenance ot �he improvement or olher righ�•ol�way use here�o <br /> L '�^.' � � � �� applied for and lurlher agrees to re ove same upon notice irom the <br /> 'I ddroved lor Constr ion Date Cily anC to rgplac public property mage hereb . <br /> �� / a-� r-y'/ � <br /> FINAL INSPE TION Date Date <br /> Approved as Constructed iynaWre of Applican� <br /> WORK AUTHOR�7_ED BY THIS PERMIT UST BE STARTED WITHIN <br /> everett PUBUCWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8010 PROJECT OVER 90 DAYS DURATION. <br />