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_ <br /> � "s� <br /> � �a�e Pu�lic Works Permit a� '��� <br /> � Blag CepLs <br /> Application For <br /> PUBL.IC WORKS PERMIT Pu�TollFeeFee S <br /> Less Apo�Fee Paitl $ ' <br />� Balance D�e � �d�0 <br /> Print or Type Only <br /> ,�«: -� �-�s�r <br /> IMMpNUEL 1-u"t�aERArI eNuQeN �5�1 ,tomBARD E�EkE7Y 98�0/ a5a - 903�? <br /> Owner Mailing Address City Lp Phone <br /> SRmE A5 ABc <br /> Applicant M;' •.ddress City Zip Phone z <br /> 0 <br /> —i <br /> DescribeProposedWork REr��cE . s FEET O� f�1�C?UR�O Sip�tJF1Z� 1��� !"^ <br />,, 1NSTALL '�D �obT [�rcopoSE/� DRiUE1,��✓ E�i'T O.JTo �.om8RK0. <br />� <br /> --I T <br /> � •-� --I <br /> N 2 <br /> 252/- o <br /> m <br /> Project Address(if known) � �Omdt' n �V�- � m o <br /> c-� <br /> Attach four(4)copies of plans tor proposed work- Draw to scale and note ihe following as applicable: � o � <br /> • Properly Lines • Centerline of sireet ♦^ m <br /> • Outline and dimensions ol all existing and • Indicate Vorth �� _ --� <br /> proposed structures on the lol • Show an?proposed grading changes m <br /> • Existing and proposed utilities • Show measuremrnls � '� �- <br /> c <br /> - — r x <br /> DO NOT WRITE BELOW THIS LINE �e� � � <br /> ( 7 < `" <br /> PERMIT CONDITIONS �� '� <br /> oz <br /> t. All calls(or inspection shall be made 24 hrs. in advance - nhone 259•881 5. � -n a <br /> 2. All work shall be performed in accordanca with ihis permit and current City of Everett Design and Construction � r;.i <br /> Standards and Specifications. _ <br /> 3. Call Location Underground Service 48 hrs. 6efore you dig.TOLL FREE NUMBER �-800•424-555J. � m in <br /> 0 <br /> o r <br /> — -- - c-> m <br /> �500 ,3�.ock � `� <br /> NoRn+ �^ <br /> ,Lom 3AR D "' <br /> � ,s,. ar.�� .� 1� ' 0'�1�- p=�1 -Zi � <br /> � • m <br /> 5�pE�ALk � _ pRoPosgo Nf�J ! sio A� ; � a <br /> - -' � <br /> -----� - , -i <br /> ��C�s1�rIG ��NERy ; ♦� _ <br /> � ' EN'IRAA)c.E '--�- � � V� z <br /> �Ie�a�a�,+ PRop�sEp � � � <br /> bFFicE E�" M � <br /> a�a� e�uR��� nR�e�,�c� ,�, � �, <br /> �o� .� z <br /> 0 <br /> � <br /> — — m <br /> � ALLey > <br /> ,( `f. /✓E/�Grx�7 /.�/jLG dE �/b/fT ACKNOWLEDGEMENT OF CONDITIONS <br /> �-,��.� T�i,Pit/ di[�Ly The undersigned owr.er/applicaM hereby agrees to hold and save harm� <br /> T.�. <br /> less ihe Ciry of Everett irom any and all claims for amages, cos s. <br /> � � expenses, or causes ol action ihat may arise because of ins�allation <br /> �--�// / 7 y and mainlenance of ihe improvement or other rigM-ol-way use hereto <br /> "7).C2!- �� �n � �� applied for and further agrees to remove same upon notice from the <br /> Approved for C tcu �ion�� Da1e City and to replace public property damaged thereby. , <br /> ..// _ 3 -�-r / ��1 �a -�y-sy <br /> FINAL INSPECTION Date ���� <br /> Approved as Constructed S� nature of Applicant Datc <br /> ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WOFKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY EE <br /> Everetl, WA 98201 �ANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATIGN. <br /> 1 <br /> � <br />