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_i //..r� J� /� <br /> Date '�n��J I Put.ic\vorkePermit• <br /> }"` <br /> Application For emo.oea�. <br /> PUBLIC WORKS PERMIT PuDTo�HFeeFee s - <br /> Laes A00�Fee Peid S !�p <br /> Belence Dua S /C"E'�n <br /> Print or Type Only <br /> . Rc�r c�.�i� 3ya-S3.�3 <br /> e 1A l��- .r�i21� St lC L�ec�u mcn,,t t�,- - f-��e�cit �18�0� asq- ��9b3 <br /> wner Meiling Addrrss Ciry Lp Phone <br /> z <br /> 1'� )1 �1 ,.1' C'�1 l� `YI Y11.e� o <br /> --1 <br /> Applicent Mailing Address City Zip Phone � <br /> m <br /> Describe Proposea Work Ve � � l dlu'1i? LO't5 3�' 3 1 <br /> b i'i I�{ (fl' lunln mC ken.i �Eco�oGy �"c�cC S ' ; <br /> � N S <br /> I*i <br /> W = � <br /> __ m� <br /> r-E��1r �.. 0 3 <br /> ProlectAddress(ifknown) ��{ �� f ���r m <br /> Attach four(4)co�ies o� plans for proFosed work• Draw to scale and note the following as applicable: � _ '� <br /> � m � <br /> • P�ooerty Lines • Centeriine ot sireet p Z <br /> • Outline and dimensions of ell existing and • Indicate North <br /> proposed slructures on the lot � • Show any proposed grading changes �M <br /> • Existing and proposed utllities • Show measurements /� ,� N <br /> W -� <br /> „ <br /> DO NOT WRITE BELOW THIS LINE � 0 3 <br /> i PERti`�T CONDITIONS '� m <br /> x <br /> 1. All c�ills for inspection sha�l be made 24 hra in advance• phone 259•881 5. � m N <br /> 2. All work shell be pertormed in accordance with this permit and current City of Everetl Design and Construc!�on o <br /> Standards and SpRcifications. <br /> 3. Call Location Underground Service 48 hre.betore you dig.TOLL FREE NUMBCR 1•A00•424-5555. � 3 N <br /> 5, Th•i5 %�EL'hti% /v1U5T ALSO !3E S"S"+�ED,/ <br /> y 7/1E lc;NE�'S O � m <br /> -�-�� / n <br /> O�LcTS 3c� ¢ 3%. /I� '�� �, ���l,y,, j -- a <br /> l.H`�^qj <br /> (, F/[.� PC/-1(E-�D t 3/� ' TNE "� <br /> OA1 iATS 3o k4GL .�v �.4iSE � x <br /> a <br /> (-,�ADE oF Ti/C 1c�TS iliv%/Ez THnN �HE A0.TqcEi�T LorS , z <br /> �30k3�� � ? <br /> 1 <br /> O N <br /> 7. FILG /i9ATE,C/dL 74.rE,�/ AGKCSS EDGE/nGr.t' LANE W�LL dE o <br /> , ;NE Gc��er3, C-vrrF.t; /� � <br /> (7pNE SO G�/Tyal.? �Y- /�dn�AGin'f• <br /> /�iL'/� S/DE/✓�1L.I.' , Tf� F/LLri14TE�idL iS iAKc-ti' �c2�Ss EOGEi�1on,i �ti�• li m <br /> TNEN fWP��cAn.'r rv1�!Sr SHoc� NE f1a5 i�Ed�»�ssioi� F,eon� 8�1�e�=r/�+��.:Ei�'� <br /> E'iTNE�2 By A LFTTEL' D.0 $/!-.v•Tv.cF OA1 %N/S PG�'/)UT, <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appllcant hereby agrees to hold and save harm- <br /> less Ihe City of Everelt Irom any and all claims tor damages, costs, <br /> expenses, or causes ol action that may arise because of installation <br /> � ��� ,�j�� .�s and maintenance ol the improvement or other righbof-way use hereto <br /> / applied for and lurther agrees to remove same upon notice lrom ihe <br /> Appr d for Corislru� ion � a�e City and to replace public roperry damaged thereby. <br /> � <br /> � <br /> .� 7 y' P f` • / �' ' " � <br /> INAL INSPECTION Date � '` � �� �' l <br /> Approved as Constructed Sig atur of Applicant \ Date <br /> WORK AUTHORIZED BY THI..� PERMIT MUST BE 5Tl.RTED WITHIN <br /> everett PUBI.IC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet 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: 259-8875 PROJECT OVER 90 DAYS DURATION. <br />