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���� � 1' !� PubL[Works Permit s �, /��' <br /> Date ' I ::�,;/� C:c� �e <br /> 6�.a9.DePI.s 'Ji" `.�y—'—l—�—'� <br /> Appli�.•alion For <br /> PUBLIC VNOFiKS PERMII" P°°To�aFe�`°° 5 <br /> Less Aopt Fce PaN 5--�— <br /> Print or Type Only <br /> TQ POSTING �� z� y BalnnceDur �_ "a��" <br /> �'12��'F''> � �.I��,dl��"��? �'a+�t�� ( 1/�� 73r<� � �i �',��f =���1P7��! <br /> Owner MailingAddress City Zip Phone c'��� <br /> ;�^,�; �,��►�� �1 a �'►�Z��I ��1��'�, l'�-�� �� �a ���F� 11�I�1�,4 �( �i � �-7 `,� . <br /> Applicant Maihng A c�ress City Lp ,� Phon= <br /> i <br /> Describa Proposed Work �L.�l � � '-����`� ���� � ������ ��� ���� <br /> - W <br /> Proiect Address(if known) �/Z/ �U�/�`"h �� � <br /> Attar.h four(4i copies of plans for proposed work- Draw to scale an�t note the�ollowing as applicable: �� <br /> • Property Lines • Centerline ol s�reet /A <br /> • Outline and dimensions of all existing and • Indicate North �� <br /> proposetl s�rucWres on the lot • Show any proposed grading chan9es <br /> b Ex�sting and Croposor utilities • Show neasurements M <br /> W <br /> �� fi0 NOT WRITE BELOW THIS LWE <br /> PFRMIT CONDITIONS � <br /> i.All calis for inspection shall be made?4 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everetl Design and Construction <br /> Siandards and SFeciticatio�u. <br /> 3.Call Location Under�round Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 5� �.eC,o ct.�. ���.e� �G�,. a�` �� �-��=- (� <br /> 5 ����� ��l�,a� �'�z'-� � <br /> � <br /> G. C�.� Gaz�rh' �r��Cc�•�.� .�..e. n:�..0 a..���zG�o/�'e� O <br /> �,� ���� -�/u.� � ����� ,r��� ����u�� L� <br /> ACKNONJLEDGEIv1ENT OF CONDITIONS <br /> 7he undeisigned owner/applicant hereby agrees to hold and save harm� <br /> ---- less the City of Everetl irom any and all claims for dam�ges. cosis. <br /> / ezpenses, or causes ol action that may arise because of installalion <br /> � � /�O /G ���� and maintenance of ihe improvement or other right-obway use hereto <br /> �U Lrfz applied Inr and further 2yrees to remove same upon notice trom the <br /> Approve or Construclion � Date City ard to replar,e public property damac�ed ihe�eby. <br /> � 'J/ � � p <br /> ��J .i i <br /> /(� , � / 1 <br /> �� � / � ' �' �, /� ;�� � - /7-0C4� <br /> o% �- <br /> FI Fl WSPECTION � Date ��'•-' . ' f ��"�`�- � � <br /> Appro��ed as Constr�cted igfiaturn of Appl cant ^� Datc <br /> �NORK AUTHOHIZED BY THIS PERMIT MUST BE STARTED Wf�HIN <br /> everett PUBLICWORKSDEPARTMEN7 180 DAVS OF �ATE PERMIT iS ISSUED 4ND TFIER�.4FTER IS 70 <br /> � 3200CedarStreel gF DIUGENTLY PUHSUED TO COMPLE710N. THIS PERMIT M1dAY BC <br /> Everet6 WA 98201 G�NCELLEU BY THE CITY UPOIJ ANY STOPP4GE OF WORK ON THIS <br /> Phone�.259-8810 PROJFCT OVEH 9'J DAYS DUFA-:ON. <br />