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- �;: <br /> � ��.-�-_,� <br /> � <br /> � <br /> � <br /> ��� vn l j�{� �t !""1 Pueuc wo,Ms Peemn• I <br /> �� Dale ��1�L� � � u r � ��1�� � <br /> Q�� ' eiao oeo� • � � � <br /> ' Application For I — --— <br /> ��� PUBLIC WORKS PERMIT �°�°°WO15`�° 5 <br /> iolnlFee <br /> A Less AppL Iee Gai� � <br /> o �O l palencc Duc $ _ <br /> �I �f Print or Type Only <br /> � iln��-bv F l�C' ( � �'.�'�' I z-! F�/�K�� <br /> �� � Owner Mailing Atltlress �ty Zip Phone <br /> ��� <br /> O <br /> �~ — Maihn Address City Zip Phone <br /> !P] APPlicant 9 . <br /> t��� <br /> /�-�-����� �� /� /� �Q / I <br /> �p M Describe Proposed Work �C ��'�.I��L��� r^^ "" • <br /> W��" <br /> OW W <br /> Pro�ect Atldress lif knownl � � - � � <br /> Attach bur(41�opies ol plans lor proposed work� O�aw lo scale antl note the following as applicable: � <br /> • Property Lines • Centerlme of street ♦A <br /> • Outline and dimensions ol all ezlsting and • Indicate North V� <br /> proposed siructwes on Ihe lot • Show any proposed c�radiny changes <br /> • Exisling antl proposed utilities • Show measuremenis � <br /> /. . -.._\ DO NOT WRITE BELOW THIS LWE � <br /> I C�� PERMITCONDITIONS <br /> . , 1.All calls for inspection shall 6e made 24 hrs.in advance-phone 259•8810. � <br /> 1 , 2.All work shall be pedormed in accordance wilh this permit and current Ci�y ot Everetl Design and Construction <br /> Slandards and Specilications. <br /> '== 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•SOO-424•5555. � <br /> � <br /> 7 O <br /> ll�T r�. <br /> I '_- ��'�"� �"' <br /> /z�� V� � <br /> I "`� e[%t� Cc/�ca�-�Y/ ,2t�_`C'�i%,n-�_....;� c.�:.GG' O . <br /> �)7CL.l,f.rL�!/ T y f� /CRu� � �// � <br /> `�J�, �, r � / t.:�l <br /> �, 'r�► �zlLt'' ✓O-�� /1�Z.(/i�%" ���Q.i,� 3 �/, - I <br /> i <br /> . ���� CG9 .��c•�✓�.r [`��- �-�l.' . _ , <br /> i <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 1�� The undersigned owner/applicanl hcrcUy agrees to hold and save harm- <br /> �_� less Ihe City ol Everett Irom any and all claims lor damages. costs, <br /> expenses, or causes ol action that may arise because of installation <br /> and maintenance ol the improvement or olher righ4ol�way use hereto <br /> applied lor and further agrees to remove same upon notice Irom Ihe <br /> App�oved lor ConsVuction Date City and to replace pubhc pronerty damaged thereby. I <br /> FINAL INSPECTION Date � <br /> Approved as Constructed Signalure ol Applicant Date � <br /> 1h'ORK AUTHORIZED BY THIS PERh11T MUST BE STARTED WITHIN <br /> everelt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PE�MIT MAY BE <br /> Everelt WA 98201 CANCELLED BY 7HE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 OAYS DURATiON. <br /> � <br /> i <br /> i <br />