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- . ' ..� x x� ,�. ;: . . . � _ <br /> •.4 <br /> � .� � ��.% ���:..� .. <br /> � A.. <br /> rt rii <br /> � � S.u.�.°;':Y4.�.`F.: <br /> . a` �.�F i v � <br /> / <br /> 8 r'�l /�W <br /> `�-/s'9a � s-" 9"� ' �v !<�� <br /> � �'3 L Pu�l¢Wo�ks Farmn• 2� <br /> �� � Date � eia9 oen� • � 7 <br /> y -�� hpplication FOr __ _ <br /> p � m .�J PuLTotalFceFee S <br /> � y y PU�1;�IG 'fNORKS PERMIT <br /> y � � p` ^ Less AoOL Fce Fai� $ <br /> c� 5 2Cj— <br /> V� f7 �� In o O o r.i �.� '- . 'f� 0alancc Due _ <br /> H %7 y_ O O O �: O u O O �J U; <br /> ,°ti H � Prinl or Type Only �, m ui o� o " <br /> o � or^ - <br /> tn H � ry r a w r� w �f� i w o� <br /> �y Ul W .y tl+ " as w � <br /> � � � ��� � W u> � �i rf <br /> � �YqSn �2o_sr.P O'O ,�' �/�� ��� 9�ao1 ,��/7--�?� S— <br /> p f�j �y °. Y Mailin Address �? -- <: '-.= [_Cii�^� yiti =. 2iP Phone <br /> r+ l+1 Ow n e r t . 9 �c� �:: r _x r., w u �.,_ u <br /> � , � ,, �� ��wc.� ui -> or- o =*, ? c- ;i <br /> �.� _.i.J �� Pr n a :� u:; ci �� �:.:. <br /> M g !L ::F 'w i1 1_ Li [:]�:�C 3 '_:. U <br /> � '� q `� —'- ziv Flwne <br /> x Mailing Address Gity <br /> N H APPlicant <br /> N <br /> ❑ C fn ����� _—— <br /> � l[q � Describe Proposed Work _�1=- S��' <br /> H N <br /> H O N _------�' - <br /> W <br /> �a r � ��.�. �...�. .ea�c � � <br /> Proiect Address(it knownl � � <br /> � <br /> Attach four(4)copies ot plans br proposetl work� Drew to scnle and note ihe lollowing as apDlicablz: � <br /> • Property Lines • Genterline ot street <br /> • Outline and dimensions ol all eAisting and • InCicate Nortti <br /> proposed structures on the lot C Shc�:�any proposed 9radin9 changes <br /> i Ezisting and p�oPosed utilities • Shcw measuremeMs � <br /> ar���t wms <br /> � DO NOT WRITL BELOW :r iS LW E � <br /> �� � �-�- PERMIT CONDITIONS � <br /> �S��`+ 1.All calls tor inepection shall be made 2a hrs.in advaocr:-phonc 2F9•881G. <br /> �w� 2.All work shall 6e performed in accorda�ice with this Fermit ano curr=.�t Ciry of Eve�eU Design and Construction <br /> . Standards and Specilications. � <br /> � 3.Call Loca�ion Underground Service �6 hrs.betoie you dig.TOLL FFLt hU�NBER 1•S00•424•5555. <br /> � I`� <{, Ar�i �r�<tsi S�a�� i N s�-r,.;� -T'+��u c.c� e� � <br /> p�A..�NS �S f�"�,`YZ G t 'i-"( S`��Q � � l � � <br /> � �„+ � <br /> I <br /> � �, . ; � � � <br /> � � �d . .,� �'� ,.� . � <br /> � <br /> � '���� <br /> � �.�� ' ACKNOWLEDGEMEN�i OFCONDITIONS <br /> I The undersigned ownedaFPlicant herel�y agrees to hultl and save harm- <br /> �_ less the CiP, oi Everell irom any antl all claims for damac�es, cosls, <br /> t�� expenses, o� causes ol acl�on that may arise because ol installation . <br /> ��, /7 ,� I�n G��,�I � — and mainten:mce of the improvamert or other ri�h4of�way use hereto <br /> ; XN� '� . � [.�7/yL upplied lor a�d lurther ag��^es lo remove same upon noti, , irorti ine <br /> � - Appwvetl lor Con tr ction / Date City and to replace public property tlama9ed thereby. <br /> � /�l% a -� ,r= �/ � �',� .� �"' S/��?�' <br /> FINAL INSPECTION Date �/�:.'��s r — p��e <br /> Slpna!ure of P ant <br /> Approved asConslructed p�.OHK AUTF(ORIZED BY THIS PER�AIT MUST BE STARTED WITHIN <br /> 0 everett PUBLICWORKSDEPARTMENT i?3G OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarSireet {'e DILIGENTLY PURSUED 70 COMPLETION.7HI5 PERtAIT MAV BE <br /> Everetl,WA 9d201 I CAi;CELLED BY THE CITY UPON ANY STOPPAGE OF WGflK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br /> `�: <br />