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��� <br />9H <br />A � x <br />C H <br />9 H Cn <br />rx> <br />yzH <br />tG C� <br />H 7J <br />o xo <br />"7 1-i '�J <br />[n H <br />y r <br />�o� <br />HC <br />O H <br />� c] C7 <br />H [�7 O <br />�y � <br />ta+yz <br />Hy <br />N <br />H <br />C] l7 U� <br />��� <br />z ti cn <br />H O fn <br />Date / — � / <br />Applica�ion For <br />PUBLIC WORKS PERMiT <br />Print or Type Only <br />� <br />Mailing Adtlress <br />,::,e�oeoi��.'v<�=n.� �%'�C._' . <br />_�_' <br />Publlcworxsfee 5 <br />Tolal Fce <br />tess AO�� Fee Paia S <br />bamnco Due 5 <br />Zip Phane <br />� c� �'z -`— <br />Applicant Mailing Address Gry Zip Phone <br />� <br />� <br />Describe Proposed Work �' �-L' �.�� ._ <br />Proiect Atldress (il known) <br />� <br />Attach lourin) copies ol plans tor proposed worh � Draw to scaie and notP the lollowing , s apphcable. <br />• Property Lines <br />• Ouiline and dimension; ol .II cxi5�in9 anA <br />proposed structures on the lot <br />• [xisting and proposed uliliu�s <br />• Centerline ol sVeet <br />• Intlicate North <br />O S�ow any proposod grading cn�n��r; <br />• ShOw n�n=sureinrnt, <br />� PERMIT CONDITIONS <br />`� t. All calls for inspection snall Ue made 2a hrs. in advance- nhone 259-8810. <br />'r � 2. All work shall be pedormed in accordance with Ihis permit and r.urrent Gp� o� Ev�;rett Des�gn.3nd Con;truclion <br />S�andards and Specifications. <br />3. Gall Location Underground Servicc 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�� �� <br />��/O�'�e, t�9z�1�-lV.�r�.��!'.�,7a�t4..�,<� <br />Bm' �' � <br />-_! �.F <br />.S-I-%'/ <br />f�CKNOWLEDG��tENi� Of- CONOITIONS <br />The untlarsigned owner/apphcant here�y aqree.s to ���oltl and save hnrm- <br />less the� Cily ol Everet� Irom any and all claims for tlamages, costs. <br />enpenses, or cau;es of action Iha! may arise because ol installation <br />and main�enance ol the improvement or other righ4obway use herelo <br />applietl for and lurther agrees to remove some upon notice Irom the <br />Approved �or Conshuclion Date City and to replace public property damac�ed ihereby. <br />FINAL INSPECTION Date <br />�PP�oved as ConsUuc�ed Si�nalure ol Applicanl Date <br />� PUL3LIC WORKS DEPARTMENT �'�'ORK AUTHORIZED BY THIS PLRMIT A1UST BE STA�TED WITH�N <br />�i I80 DAYS OF DATE PERMI7IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Strer.t O[ �ILIG[NTLV PURSUC 0 TO COMPLETION. THIS PERMIT MAY BE <br />�[va�^.11, V✓A 9fl201 ';f�NCELLi_� [�Y TIi[ CITI' UPON P NY STOPPAGC OF WURK ON 1 HIS <br />Fnoir.:.2�..?�OC70 PROJGCT OV[R 90 DAYS �Uf7AilON <br />