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I <br /> ��� Date . r�m��wo��sve,m,�. �7—_�/ l <br /> ��� • Application For oma,Oen�.• — <br /> PUBLIC WORKS PERMIT rubTo�alFeeFee S <br /> �F]� �oss noo�Fco vem 5 / � <br /> HDalance Duu S •,C�� I <br /> �G+ t+ Print or Type Only I <br /> �p� <br /> Hb <br /> �� Lf�STMou'�' t�(� PF�-tG��rlt���Tn��R5F4�P� Wt� �F�ral�s� �l�#31b SY:A'�li u1�I• 151�`� � <br /> Owner ailing Addre�s City Zip Phane � <br /> 4• <br /> �H ����� R 5���,y r��J �ti1h NAC-,ER� �?o (1`1�.��� �-�1�E'�iMri��i �P��,dr /�Pt�R�.�s <br /> `. Applicant Mailing Address City Zip Phonc <br /> Z 8 2-00�/ <br /> �� Descri6e Pwposed Work � � � — � C / �i:�� 2"�9'aZ��P�y� <br /> � � i <br /> i <br /> a� � / � <br /> T Prolect Address(il known) �.�� T C N �� �J>N � A � <br /> Attach four(4)copies of plans lor proposed work• Draw to scale and nole ihe lollowing as applicable: � <br /> • Property Lines . • Centerline af street /� <br /> • Outline and dimensions ol all existing and • Indicate Norih V� <br /> � proposed siructures on Ihz IOI • Show any proposed e�radinc�changes <br /> � • Existing and proposed utililies • Show measurements /y� <br /> j W � <br /> I �� DO NOT WRITE BELOW THIS LINE � I <br /> ���� PERMITCONDITIONS � <br /> I <br /> 1 i 1. All calls lor inspeclion shall be made 24 hrs.in advance-phone 259•881 5. ^ � <br /> 2. All vrork shall be performed in accordance with this permit and current Ciry ol Everett Design ond Consiruction ♦ I <br /> .�'� Standards and Specilications <br /> � =�� 3. Call Location Unde�ground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> i <br /> � �__ y �-� �..-���,�.-c � � �% O � <br /> I --' <br /> �5. <br /> ���s��:,v <<. ,���:� ��:,, `>���-. �;�,� ��y �, ! <br /> '� ��- i^����'r c�c�,c� w <br /> '� `" f�ro,�-� Tc r"'�J �E.cn�iT /SS!-/;c'!f ) / <br /> il O <br /> �- �/y,v,�.��_r��c� ��c��> -r���-�,E�����_ <br /> � . � _ -_--- �-�„�. F�S�E oE�r '� � <br /> ' I G f�i,�C �-/�F�i� i � � - <br /> —�� , y. r //s-�3�i <br /> , _, <br /> I '+� ACKNOWLEDGEMENT OF CONDITIONS <br /> i � <br /> � �v� The undersigned owner/applicant hereby a9rees to hold and save h,rm- <br /> � less ihe City ol Everett Irom any and all claims tor damages, costs, <br /> l, ezpenses, or causes ol action that may arise because ol installation . <br /> J �'j' � J j and maintenance of ihe improvement or other right•oFway use hereto , <br /> �" ' �� applied for and lurlher agrees to remove same upon notice from the <br /> oD oved I o tr, ion ' Dale City and to replaco public property damaged thereby. . <br /> / <br /> FINAL IN PECTI N � � p� "" � � ��� II <br /> Approved as Construcle �c�n�ture ol A plic �e i <br /> PUBLIC WORKS DEPARTMENT R< AUTHORIZ Y THIS PERh11T MUST BE STARTED WITHIN <br /> everclt 18 AYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO � <br /> � 3200 Cedar Stree� BE DILIGENTLY PURSUED TO COMPLGTION.THIS PERMIT MAY 9E � <br /> Everett,WA 98207 CANCELLED BY THE GTY UPON ANV STOPPAGE OF WORK ON 7HIS <br /> Phone: 259-8815 PROJECT OV[R 90 DAYS �UR�TION. <br /> i <br /> I <br /> I � <br />