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� <br /> � -, <br /> . � <br /> 9 �.(�' � <br /> �BtB • � Puel¢worM.P.� it. `-� � �Z-.� <br /> Applicatlon For 6100�Deot• �� <br /> PUBLIC WORKS PERMIT P°°t;,;°F eF°• , —� <br />' Lsu Apol Fae Pe1E S <br /> B�I�nce Oue � �� �U <br /> Print or Type Only ,/Q 9� <br /> �� �/�f�l, P�e. �al s��� ��7-t n�A c ( W-, �- � � <br /> Ow�— Meiling Address Ciiy Phone <br /> z <br /> `�^- � o <br /> ��� � <br /> Applicant Mailing Address City 2ip Phone � <br /> m <br /> � Deac�ibe Proposed Work NP� SF� <br /> M M <br /> ""� � <br /> N .�-� <br /> Nm <br /> W = � <br /> m� <br /> Pro�ect Address(if known) -� C� — > - � o � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicabte: � _ � <br /> m <br /> • Property Lines • Centerline of street � <br /> • Outline and dimenaions of all existing and • Indicate North c Z <br /> propoaed structures on the lot • Show any proposed grading changes � _ <br /> • Existing and proposed utilities • Show measurements � �� <br /> --1 tn <br /> � �l <br /> DO NOT WRITE BELOW THIS LINE O T p> <br /> PERMIT CONDITIONS = m <br /> 1. All cells for inepection shatl be made 24 hrs. in advance• phone 259•881 5. � m ,.., <br /> 2. All work ahall be peAormed in accordance with this permit and current City of Everett Design and Construction �^ <br /> Standerds and Speclficationa p � <br /> 3. Call Location Undergrountl Service 4B hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � � � <br /> 3 N <br /> i c� <br /> O .�m <br /> A <br /> � � <br /> 2 <br /> a <br /> z <br /> � � <br /> x <br /> ., <br /> O N <br /> z <br /> 0 <br /> a � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appiicant he�eby agrees to hold and save harm• <br /> less the City of Everelt Irom any and all claims lor damages, costs, <br /> ezpenses, or causes ol action that may arise because of installation <br /> �r//�,� / ` ��/•�� and meintenance ol the improvement or other right�of-way use hereto <br /> L'""'!� 'G'r "�'�' J app!ied for and lurther agrees to remove same upon notice irom the <br /> AFProvedlorConstructionLC�C"— � Date � <br /> City a replace b' op ty damaged thereby. <br /> � 3/�f'- <br /> '�FINAL INSPECTION Date <br /> Approved as Constructed Signature o plicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE ST�RT D WITHIN <br /> ' � 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 90207 BE DILIGENTLY PUFiSUED TO COMPLETION. THIS �ERMIT MAV BE <br /> Phone:259-8815 CANCELLED 8Y TFiE CITY UPON ANY STOPPAGE O�WORK ON THIS <br /> PROJECT OVER 50 DAYS DURATION. <br /> 1_ J <br /> ------..�-- --- -----_—.�.�-- --._.-_..._,�.._---_..._ <br /> _ . _ . _ - -- <br /> r�.,.�t � +, r� .. r n '�!�`,y � : .. . . . ... . . . . <br /> � i <br /> '�� � " � r � $ � ._ �.; �'` 3 . . . <br />, 3 � �� .,t.. _ts 3:rx .��_��. <br />