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i <br /> I � <br /> � . � <br /> n' <br /> � �[� � <br /> b A C / I <br /> C M <br /> � N V. �� _ nub�¢vlo�ks V'�Ymil� � � —.— �� <br /> �// 1 p ��(� <br /> H � 3 Da+e t_�i� � <br /> [+��q oao� •-_-lQ��-![/.:3-'-__ <br /> K y � APvli:;atiun For - ______ 'i <br /> ° H � PGIBLIC WORKS P�RMIT '°°"`w°`"„Oe — � <br /> y H TuIAIFee 5 <br /> y � Less PO�L Fee Psi1 S�--- <br /> � y J Baiancc o�a_�S_�� I <br /> °� � o Print or Type C)nly ' <br /> c� • n � <br /> zqy � p <br /> z �, , , /�.�-/I,,�,,n� i �r� � l�.'_l=��r!r'�--t���� 'I <br /> Ot~n y Ownerr Mailing Address City uo Phom� � <br /> f� O In �1U�I'�7GC.J(..(.l <br /> � � � I k„ (1 �r�lw,H�.ac 5,?�� ,�;k P_ Jf S�ofi�l�—�-�io� _ <br /> y � � ApGlicant Mailin9 Address Ciiy Zip Phone <br /> � r l� //�,.///l�i.r �-(�CX.�Lf/l��l� — <br /> Describe Proposed Work �R- �����-`-�j----� � <br /> ��O/;'- /v�d9iL0 --- I.i� <br /> � -,_ � i � �� � <br /> prcl��� Address lil known) �`-—'^—`�'Tf— <br /> AtlaUi fau(4) copi?s nf plans for proposed work� Draw�o sc..ie am7 note the lollowing as applicable�. �� <br /> Y Property Lines • Centerline ot sireet . <br /> O Outline antl dimensions o� �II existin; antl • Intlicate North �� <br /> prouosed structures on the iot • 3how any propOsed gradmr� cF�.nge5 <br /> % � • Existing and propused utilities • Show measurements � � <br /> � � ` . I <br /> � <br /> '��rt � DO NOT WRITE B��HIS LWE ,y l� � <br /> � PERMITCONDITIONS !*� I <br /> � ��, �� 1.All calls for inspection shall be made 24 hrs.in ativance-phr,ne 259•8810. � <br /> R ' 2.All work shall be pedoimed in accordance wilh Ihis t�ermit and wrrent City ol Everett Desgn and Conslruction <br /> � Standards and Specilications. <br /> � 3.Call Location Untlerground Service 4R hrs.before you dic�.TOLL FREE NU�ABER 1•S00•424•5555. y I . <br /> a+ <br /> i <br /> P ` 7, CG/C/ c��'i..L.a� L?i}l, � GLC �lL�-'� 't-�cf4„-tl Q� ct,l( -e%?+ir'�+' � �'I <br /> i v� � <br /> /1 � [ � ��I �t I <br /> .7 CL`�YeM-�'.t�i•0'�"p' ��C�luL4/ ..L�(:c�(L'-u� �CC7 =�7':�.cCi�� � I <br /> �,�2fc.�c*���i�in�-- I �,_ . <br /> � � � <br /> —_ ,�,�� ; - 1,-� � ' <br /> ��� ����'�� 5 ' � � '. <br /> � � c <br /> �.,.. , ,. � �. <br /> � �� w ����� �7�,, ��� . ,= , , ���� � <br /> , �� ����--,r�; � <br /> ' ,,,,, � <br /> I �im�I,t I. � /W�, � �/ i / ACI:NOV�'IEDGEtdcNT OF CONDITIONS � <br /> � � �/ The�ntlersigned owner/:.pplicant hereby �9�ees to hold and save h�rm- . <br /> � less the Cily of Evere�t Irom any and ��� claims lor dzmages, oosts. i <br /> ezpenses, or causes of action that may arise because ol insla�lation <br /> � /�� � and mainlenance �f �he improvement o!other rigM-ol�way ose. I�ereto � <br /> �- L;'�� ___ applied lor and furth.er a9rees to remove same upon notice ircn� Ihc <br /> Approvetl for CnnstruC(ion � � � Date f,ity and to replace pubhc properry d�mayed ihereby. <br /> ny-�� ' <br /> _ / /_� � 1:< <^,o <br /> Oate �l ' -7�-- <br /> FINAL INSPECTI N � Signatu.c of Applicam �'�` <br /> Approved as Cons�ruc�ed <br /> WORK AUTHORIZED 8Y HIS PERMIT MUST BE STARTEC WITFIIh <br /> � everett PUOLIC WGRKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS ('� <br /> � 3200Ced:vStreet BE DILIG[NTLY PURSUED TO COMPLETION. 1HIS PERMIT MAY 6E <br /> Everett,WA9820� CANCELLED BY THF GITf UPON ANY STOPPAGE OF WORK ON ThIIS <br /> Vhone:25b�8910 PROJECT OLER 90 DAYS DUR�TION. <br /> R <br />