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. <br /> t <br /> � <br /> �/ rwKwa+.r.n�.� f!y �f �' <br /> � �a�@�� / . -,. . , . . • . _ `i!�: 9,4.r.. . � . �.�•.. 0 c.�': <br /> ,.. !� �. . sioo.o.oi� <br /> . � � .. . , ,•AppllcaUon For - . �`- . <br /> . ::.. - . . ...,.-.:. <br /> PUBLIC WORK� PERMITh � ^'"""'""`" <br /> ,a,�F.. s �-o. o 0 <br /> ,ti � ,; � , ' �� <br /> . . '. . . *'�� .��..... - ' T ' � .it• . tw MOt Fw P��O � � . <br /> , � r �, r� <br /> � .'.. : •� . e ' MrnwDw {�O•�O <br /> '� Print or TyPe Only w , ; �.' • '•- <br /> ' dd9� <br /> , , - . � .. <br /> ,. , . : _ " .:� �d03 3S,S- �93`f <br /> � eo�e��''� ow�A3' C'o00� ��+wrn�crR� �T <br /> pN,�� �� MeilinpACdrens . �• .•Clty � Lp Pbone <br /> ,i:.F,.=..' <br /> �►�e ; . <br /> Applicant . Mallmp Addross Ciry ZiP Phone <br /> DescribeProCosedWork �w�J� e'�arr,aor.sz P.2P�.�..aoae ����.54 yv ���in:j J' cc � <br /> � J <br /> o� �-� , T <br /> � .Ar� . � <br /> Project AOdress(it known) C�, � <br /> Attach four(4)copies of pla�s for Droposed work• Draw to scale and note the lollowinp as applicablo: �� <br /> • Property Lines • Centerline ol streel � <br /> � Outline and dimensions of all eristing and • Indicate Nonh <br /> proposed structures on ihe lot • Show any Proposed gratling changes <br /> � Existinp and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs in advance•phone 259-881 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current City oi Everett Design and Construction <br /> Standards and Specilfcetions <br /> 3. Call Locatfon Underpround Service 48 Ars belore you d'p.TOLL FREE NUMBER 1-SOO-424•5555. � <br /> � Ead,. �Id� w.,��� b� cor.,a��.9 w s�e�.•�e s ,�le stV.•er O <br /> T� �C W�A�r � INC �t✓ �Ol Ah S�O W 1 �t Sf W G� <br /> \ 1 ��,^ �6.s. 9�,�., �p..� �.�...4- ��,.�,.,� ,:.�,. N� �x�s+��� <br /> �Q.a1t S��t waf WMi� �S NOT Ptfw•�rJ/ AwY �� 1� � <br /> GIf�0.M �l�Tl Q � Sh\1WN �1 W�Mtir b� O�' �C�'fW IM� � <br /> � 1 a+ S�G��t Cov�.�ecY.oH1, ' . . <br /> � .S/n►czt.E' s�DE sE�s,�¢ /rl�tcJ'r' c�`� -� <br /> ttlC�iAD�,O ?a �s •• � <br /> ACKNOWLEDCaEMENT OF C ITI NS ` <br /> � � The underaipneC ownar/applicant hereby epreea to hold and eave hurm� <br /> . , less the City ol Evoretl from any en0 ell claimo for demape4 coets, <br /> � expenae& or causeti ol at[ion t�et mey erise becauee ol �netellation <br /> �/� �/ and maintenance of the ImDrovement ot other riphl•ot•wey uee hereto <br /> �"�'� �ro"�! �PDlied or and turther agrees to remove eama uDon �otice from tAe <br /> o ed for Canalruction � Date ppy e d o eplace p lic proPe demeped tAereby. <br /> FINAL;NSPECTION � Date pna ure of ADD�icant Date <br /> Apprrned as Conetructed � <br /> � � � ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evereK PUBLIC WORKS DEPARTMENT � �Bp DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceda�Street � � BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY'JPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•BB15 pROJECT OVER 90 DAYS DURATION. <br /> 1 <br /> 7 <br />