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.--._. �..___ _� __ . . . ..�_ __ . __.�..-,;,_. �.--�.._._._ , <br /> --�-�----� , <br /> 1 � C ' � �, Public WorMs Permlt� ✓ ��— �7� <br /> ,pate�� � P/ — <br /> � BItl9.Depl.+____.E�t�_ <br /> Application For <br /> IPUBLIC WORKS PERMI� � P°°'"N°`""" <br /> To1al Fee s <br /> L¢SS RpOI FBB PeIJ $��— <br /> , Batance Oue S �'a <br /> Print of Type O��I�� <br /> R�'w�_'_ A2�.�a� .1�� �`�ol Zt`�=� ST St (�Y+c���s.�v��4. �fnCS�2. -1-7�.-i-701 <br /> -Owner • Mai{ing Address City Lp Phone <br /> -:����.�•, -- �.�-.r� <br /> qFplicant Mailing Address City Zip Phone <br /> . ,�� <br /> Describe Proposed.Work � 'T �`��'"'w �� � N C��L-� 't-�'�'�-�Lh- _ <br /> -- � 2l-/ � <br /> Project Address(if known) �� �_ — �A-'�" y�-'r � � <br /> Attach four(4)copies of plens for proposed work•Draw to scale and note the following as appiicabie: � <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed st��uctures on ihe lot • Show any proposed yrading changes <br /> � Existmg and proposea utilities � �! Show measurements M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All celis for�inspection shall be made 24 hrs. in aavance-phone 259•F81 5. ` �� <br /> 2. Ail work shall be pertormed in accordance with this permif and current City of Everett Design and Consi:uction <br /> Standerds and Specificaticns. <br /> � 3. Call Location Underyround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•80� •424•5555. � <br /> , � - �,✓ <br /> � /F Or<'�dEuJF' " Fv,� Ts�iS LoT C.�ossFs c� vc.� GoT 3 O <br /> .. �ASEn�EnJ�l7UCuinc�n/T l�����T Bc .ecT Gu't1c� 9itl(� F� � <br /> _ �.o>>y T y .ve�l� L�/ T Ti/e" CiT� P��c t iG ��-a�;_rS .DEr"T. <br /> ��„�,�...a�- � <br /> � � n. N <br /> -r-�--�- O <br /> , > �- , _ <,��.:� ,.;�,,,- -r„�.� �� a <br /> J`� 2 G C.0 ._;:�/../C"r /S / ._ _ <br /> l.,�->„-.r �Jo%:- �% <br /> -...ci Ti�-r- •,ii?�: ...� _;t-..� il.�0i7/:; r'I%. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — less ihe City of Everett from any and all claims for damages, costs, <br /> / �- � i expenses, or causes of action that may ariae because of instellation <br /> �� �^ � � and mainlenance o�he improvement or other righbohway use hereto <br /> '4rf'i �� `"�r`� '/`� ���/�`— applied for and fu/iher �fjrees to remove same upon notice from ihe <br /> A�ved tor Construction �a�e Cil and to eplac�publjc properry damaged lhereby. <br /> I <br /> 1' <br /> � `' �.���n _ <br /> ' FINAL INSPECTION � �a�e - — Date <br /> Approved as Constructed Sipnatur of Ap�licant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett F'UBLIC WORKS DEPARTMENT 780 DAVu'ilF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BF. <br /> Everett WA 98201 CANCECLED'BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•88:5 PROJECT OVER 90 DAYS DURATION. <br />