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� <br /> ���.-�._ <br /> E� � � <br /> m � x <br /> C H <br /> > H t/� <br /> 4 <br /> H � 3: � <br /> �'4 n Date �'��� `� PuOLCWorksPe�mi1• � <br /> h � <br /> � H � Application For emo.oeo�.+ 9� �s39 <br /> �o� PU�LIC W4RKS PERMI� Pu0licWo�kSFco S <br /> Total Fee <br /> H l7 i,.,;<oni r�„a.�„� 5 <br /> O H e:danm o�0 5__ - <br /> H � o Print or Type '�nly — <br /> [�]V n <br /> H <br /> � H g // <br /> � � :L � � ��./ /�"»�',C, ^.?/C �G':�i�Ri7GC� �_✓ �%f�)c .� _ :i C:: 77 _ <br /> H f3 Owner Mailing Address C�ty Zip Phone <br /> d � <br /> coi a cHn �a/?/rs� ,� .��� ,�59 - 5U 7� , <br /> �� � Applicant Mailing Address Ciry Zip Phone <br /> y0 �� <br /> Describe Proposed Work .� <br /> ' X/ vL- / � <br /> Project Address(if known) �LOrx b��� _ � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the folicwing as applicable: �� <br /> A Property Lines • Centerline of slreet � <br /> s Outline and dimensions of all existinc�and O Ind'„ale No�th <br /> propos2d struGtures on the lot O Show any proposec grauing chenges <br /> • Existing and proposed utilities e Show measurements Y <br /> r» <br /> ��.o r��� � DO NOT WRITE BELOW THIS LW E �++ <br /> ~_` � <br /> PERMITCONDITIONS <br /> � �; 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> I 2.All work shall be pertem-�ed in accordance with this permit and wrrent City of Everett Design and Construction <br /> � ��e Standards ar.d Specilications. <br /> �, �,� 3.Call Location Underground Servir.e 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �� �i !�,� <br /> i <br /> � / i 7 � <br /> i � � � <br /> 1/ <br /> i�, �.1 i U �) �i (� ,� ��' � � � �r �. y- nt i �C[� � <br /> '� / <br /> �e � <br /> �!w� l/�j�ll�- , 1d <br /> ��0.�� / � Zr- �l�' Ll' <br /> � ACKNOWLCDGEMENT OF CONDITIONS <br /> �l '�"`�w,� The undersigned owner/applicant herehy ac�rees to hold and save harm- � <br /> \,_ less Ihe Ciry of Everetl from any and all daims for damages, costs, <br /> � expenses, or causes of action ihat may arise because of installation <br /> and maintenance ol ihe improvement or other righbol-way use herelo <br /> appli�d lor and luriher ag�ees to remove same upon notice Irom the ��� �� <br /> Approvnd for Const�uction Date Cily and to replace public properiy damaged ihereby. �I <br /> FINAL INSPECTION Date �� <br /> Approved as Constructed Signature of Applicant Date � <br /> I���/ PUBLICWORKSDEPARTAIENT WORY, AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN . <br /> � 3200CedarStreet 180 DAYS OF DA7E PERMIT IS ISSUED A�D THEREArTER IS TO <br /> ' Evere�t,WA 98201 BE DILIGENTLY PUPSUED TO COMPLETION. THIS PE4MIT MAY BE <br /> Phone:259�8810 . CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 UAYS DURATION. <br />