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` ... <br /> �-., <br /> C <br /> �. . <br /> / <br /> Gl r �V � . Pu�Lc Works Porml�� �/�/ — � �2 <br /> � y Date-_ �Ci c ' <br /> eiea oco�.+ <br /> yy y � � ApPlica�ion For <br /> y � � PUBL6C WORKS PERMIT PUioaiFecFee S <br /> rC �, � L¢SSAOVtFcePaW S _ _ <br /> C Ql O � e �,. '/, <br /> Kf H �V uar�� e o�c 5 <br /> y '" Print or Type Only <br /> c�ao � <br /> H O <br /> H � r� �cr 'Tl O E 'ra� t✓ Q 1 2 t`6 - 92 2 2 <br /> � � � Owner A � Ida lin �ddress City Z�P Phone <br /> z y � <br /> � N y M A fi T Ns 2750 /✓ 7�.4 t✓ r (iot/=vi,e+- 9uoQ.� X22 ' ?'7HN <br /> nb y qpplicant Mailmg AddresQ s� Ci�y Z�p Phone <br /> � CC9 [+ <br /> � c w [/ s7� 'T' ' F��r' <br /> DescriUe Proposed Work ���� ���o�reT T•�aE—�ntl� - � <br /> H O fp w • <br /> . 'ii _ _ . Lr -� // � i2 noNT,L—� n- r h ' �.+na✓,rd d�/ Nnrc% i l99/ <br /> '7 _ � <br /> ProlectAddressli� known) ��^� �� w� - �'v�r[7� Z�?�.Yfss! ��' � <br /> �� <br /> Attach four(4) copies ol ptans tor proposed work� Draw to scale and note ihe following as applicable: � <br /> • Pioper�y Lines • Centerline o�sVeel . <br /> O Outline and dimensions ot all existing and • Indicate North <br /> proposed struclures on the lol • Show any proposed 9radiny chanyes <br /> • Exis�in9 and proposed utilities • SYow measuremeNs � <br /> DO NOT WRITE BELOW THIS LINE � <br /> / <br /> � ��� <br /> , ,r; � PERMITCONDITIONS � <br /> '�� � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be peAormed in accordance with this permit and current City of Evere�t Design and Construction <br /> ! Standards and Specifications. � <br /> � I�_ 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � '�. <br /> i i ' <br /> �q� ( . ; � �_. , �. � .'� ' . . _ /� <br /> � �. , . _ . l ■ � <br /> „ <br /> .I `.. , . . . . ._�. <br /> . . � F-, �.-' •..� 1 , . ' <br /> ; , i.\ ,� ;., �.,[_1t �-�i� r �, v <br /> f�„� ` _ � rL�� g< �d,�,.'l'>�<L- J>c��_t\ C �� i � <br /> I o► <br /> - 1 � \ \c.lr4l� <ICDC��'l`; 1,��\'�a-�i-\ �/(•Y�`� ' � <br /> ,� ��.•4��c.�� ��� � `C�h�1i.L, C���,NA=-� � -�+ �-�-���-�c_�. k A-. 1 ; , � <br /> _� /� <br /> �1��=,`�,l "Y�� �1A't �.1\rdli t_ _�C`� -l� 1 �C �t �f�_tr � � ' -� � � <br /> ` �lt=��((��"l_ t ��.i �t- ��_� -; ,�=� <� -r- �S�s Ar��ac�l,_i�� 6.L <br /> ��1 � <br /> �. ACKNOWLEDGEMENT OF CONDITIONS ' <br /> � . The undersigned ownedapplicant hereby agrees lo hold and save harm� <br /> I less the City of Everett Irom any and all claims for dama9es, cosls. <br /> �� �' � � ezpenses. or causes ol action that may arise because ol inslallation <br /> \ � ,i ; and maintenance ol the improvement or other righ4ohway use herelo <br /> 'i applied �or and furlhar agrees �o remove same upon notice Irom tha <br /> Approved��for Cons u ion Date Cily antl to replace public property damaged thereby. <br /> � i-- I' <br /> .-- `�� i,•/ - �!-�� �� Q � /�_ � <br /> r� �_ r ,n <br /> Date , .. , ll �,�=f� ��"r�/J2 <br /> FINAL INSPECTION Sign'ature of Applicant Date <br /> Approved as Construcled <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �������� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE �IIIGENTLV PURSUcD TO COMPLETION. THIS PERMIT MAY BC- <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:253-8610 PHOJECT OVER 90 DA�S DURATION. <br />