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y M <br /> ro � <br /> b m <br /> C N <br /> Y � N <br /> . <br /> Kn �ate '� -1 9r/ � �,�����,�,�,,.�P�•�m�,� <br /> H z o�oo o�m . �� n2`/� <br /> O p1 O Application Por �— <br /> ro � ro <br /> � y � PUBLIC WORKS PERMIT °°°'°W°�"`�° <br /> x ,a,i F�� g <br /> � � LessA00��Fee�ai� S <br /> M <br /> �alnnce Oua S <br /> � :° � Print or Type Only <br /> � y ��S N �`: (��+ Kn��P /' G I�.0 �'!y m.N�m�/:,/ �v i 4/7�' QQo?O-3 .353 7dcF-7 <br /> f� u t~n Owner / Mailing Address Ciry Zip Phone <br /> � tCC t� <br /> � ��'. �xc '� rn,u� I/�l7-�Dy"Sf�� Lafe I'��✓n� cG�/f� 33 �/-9�6a <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �Y� ` <br /> W <br /> Prolect Address lif known) <br /> '�- I- <br /> Attach lour(4�copies of plans for proposed work� Draw to scale and nole the lollowing as applicablr. �� <br /> • Property Lines • Centerline ol sireel /^ <br /> - • OWline and dimensions ot all eaisting antl • Indicate North V� <br /> j�� proposed slruCtures on ihe lot • ShOw any proposed graAing changes <br /> • Existing antl proposed utilities • Show measuremems � <br /> � <br /> ' ` � DO NOT WRITE BELOW THIS LINE O <br /> I '�� PERMIT CONDITIONS <br /> �� 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> , 2.All work shall be pe�tormed in accordance with this permil and current City ol Everefl Design and Construction <br /> ' Slandards and Specifications. <br /> � 3.Call Location Underground Service 48 hrs.bebre you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> I �� O <br /> ��� � ��-�^� ,-� ��c:,— k�ct�_ � <br /> -.1 1 �7�(�:u�1�u=y�- <br /> � <br /> " ���i � <br /> � a <br /> ,__ <br /> __�. <br /> ACKNOWLEDG[A1ENT OF CON�ITIONS <br /> The undersi�ned owner/applicant hereUy agrees to hold and save harm� <br /> less Ihe Cily ot Everett Irom any and all claims lor damages, costs, <br /> expenses. or causes ol action that may arise because ot installation <br /> and maintenance ol the improvement or other right-obway use here�o <br /> applied lor and lurther agrees to remove same upon nolicc from ihe <br /> ApProved for Construction Date Ciry and to replace public property damaged there6y. <br /> FINAL INSPECTION Date <br /> Approved as Conslruded Sipnalure ol Apuliwm Date <br /> ' WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />' everelt PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTE(7 IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED 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 />