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,.�., • -, <br /> �I�I VotD�c WarFe Pcimd• <br /> � � � Date o��„o��� .�i /�r ss�y - <br /> Application For � <br /> '° � PUBLIC WORKS PERMIT '"°'","°,""° $ <br /> ,o,�,F=� <br /> � y N �ese noo�Feo r.,�a 5 <br /> y �' M � Baiance Doc S __ <br /> o m o Print or Type Only <br /> � N N <br /> o � � � e I-� � f� S�3�t �(r�. nn� C.�� If' �t�'L�3 oZSz-79oi� <br /> � n O Owner <br /> Maihng AAdress C ty c n <br /> zy ."3 E�a -F`�?b-G�sTR'�f-ic"1zu /��nlc ly�GS d2o�.ti�/ .��/aon��.sh r/829C1 �i �S-/ •1d 7 — <br /> �+ x Applican� <br /> Mailin9 Address City Zip Pho � <br /> I-1 H f 1 <br /> y 't� nln + l-czJ*' <br /> '" �j /� /�or �' nn ��r-,� <br /> � y Describe Pwposed Work <br /> � � r — <br /> ca ca <br /> � oy W <br /> Project Address lil knowN �r/'' r/�r U//1'� J � — � <br /> � <br /> Attach four(4)copies of plans for pmposed work� Draw to.�cale and note Ihe lollowin9 as applicable: � <br /> • Property Lines • Centedine of street <br /> • Indicale Norih <br /> • Outline and dimensions of all existing and � Show any proposed�radin9 chan9e� <br /> p�oposed strucWres on the lot � Show measurements M <br /> • Exisling and proposed utilities W <br /> �O NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS ^ <br /> � � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> � ��'� 2.All work shall be performed in accordance wi�h Ihis permil and current City of Everetl Desiqn and Gonstruction ♦ <br /> � Standards and Specilications. � <br /> � 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> il __ <br /> ��.1 ��v� Gucs��- f� /1��' ��.��� � <br /> y-��,���/�— �♦^' <br /> , �..,� 3-i-I/ V♦ <br /> � � <br /> -- a <br /> r_� <br /> J <br /> � ' ' , ACKNOWlEOGLMENT OF CONDITIONS <br /> � <br /> I The undersi9ned owner/applicant hereUy a9rees to hold and save harm- <br /> � less the City of Everett irom any and all claims lor dama�es. cosls. <br /> �_ exPenses. or causes ol action Ihal may arise because of installalion <br /> � ' ' and mainlenance ol the improvemenl or other ii�hPof-way use hereto <br /> �� applied for and lurther a9rees to remove same upon notice �rom the <br /> qpproved for Construction Date pily and to replace puhlic property damaged IhereUy. <br /> FINAL WSPECTION Dale Dale <br /> Signalute ol APPlicanl <br /> Approved as ConsUucled <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI� <br /> �����«� PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE i'[RMIT IS ISSUED AND THEREAFTER IS TO <br /> w1 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> UEverett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON fHIS <br /> Phone'.259�6t310 PHOJFCT OVEii 90 DAYS DURATION. <br />