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_ �� <br /> S <br /> � <br /> �7/� � <br /> ���tl " �/� � , �.,` <br /> Date�� ' r�er�c wo���aP,mn• s—� <br /> � oiea o�o��• <br /> p � Application For <br /> � PUBLIC WORKS PERMIT °°b"°"'°'"'F°° <br /> Ta�o�Feo � <br /> M �ex.nnoi.Fvv rem 5—�--r,—T <br /> K � �aiancnDun 5 /`��� ��? I <br /> O�� Print or Type Only <br /> MI <br /> u <br /> ��� i.i-crr„�oN� 1�2ofa�LIT�S �`�1`I �a�r�(1 I�o�t3« ��A'('t�E�N •98iE1� 2,g�oo71 <br /> O H Owner Mailing Address City Zip Phone ! <br /> /� / � I <br /> p`� .�'OrF�J 1� �1f�4d�X}'�aAr�4'11.� 'JQ �"�f-Q,\� �►JtSi H�( f SAME A3 lr$fl✓�- <br /> �y Applicant T� Mailin ddress City Zip Phone <br /> � Describe Proposed Work S 1(t�-- �e Ra�n���� S'�oQ..M �2A���C'i S�W�� li, <br /> y�w sy ST�t�I P� ,�,� ni� $ �- ManscAPi t�6 — <br /> sa� .�---��s�T���T- ;s-�� .=��- ,�_ �—���= W <br /> �� l I <br /> . ._ }- Pralect Address(it known) ���% �� L ���i%i�N � <br /> �/` / I <br /> APach four 14)copies ol plans lor proposed work- Draw to scale and notc the following as applicable: � <br /> • Property Lines , • Centerline ol street � I <br /> • Outline antl dimensions ol all existing and • In6icate North <br /> proposed strucWres on the bt • Show any proposed grading changes ; <br /> • Existing and proposed ulilities • Show measurements M I <br /> W <br /> � DO NOT WRITE B[LOW THIS LINE O <br /> I���� PERMIT CONDITIONS � <br /> � 1. All calls for inspeclion shall he made 24 hrs.in advance- phone 259•881 5. � � <br /> 2. All work shall be perlormed in accordance with this permil and current Cily of Everett Design and Conslruction � <br /> 1 � Standards and Specifications. <br /> _ 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424-5555. � ' <br /> �' <br /> i ��� y /'`�' ��/'.FL�..1� /�Lff.2LI' � ��'� t�� O <br /> � � �� <br /> I -- ( ���.�-�«- � I�� � � ��,Q �S , �I��II�7 . ��- �— <br /> � <br /> �-- � Q <br /> _� <br /> a <br /> �,_, <br /> � ACKNOWLEDGEMENT OF CONDITIONS � <br /> � The undersigned owner/applican�here6y agrees�o hold and save harm- <br /> less thc City of Everetl Irom any und all daims lor damages, cosis, <br /> "��� __������–'�" ' expenses, or causes ol ac�ion �hat may arise because of installation <br /> / � j v � ,� and maintenance ot Ihe improvement or other ri�h4ol�way use hereto <br /> - � � ' -' r.�.� ,.� "� � � ��� applied tor and luriher ac�r es �o remove same upon notice irom ihe <br /> Appfoved jo Cq struction j ��� � , � � Date City and to replace public operly damaged thereUy. <br /> �� � � , ��� �� <br /> /. ��' , �%� / � �� � . <br /> c- � � , �,. <br /> FI—t�I�JS CTIbN �/ ` �� � Date <br /> ApproveA as Conslructed / ignal�re ot Applicant D te <br /> everclt PUBLIC WORKS DEPARTMENT ORK 1UTHORIZED BY THIS P iMIT MUST BE STARTED WITHIN <br /> i YS OF DATE PERMIT I ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar S�reet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV B[ <br /> Everclt,WA 6�201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8�15 I PROJECT OV[R 90 DAYS DURATION. <br /> � <br /> li , � <br />