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/ <br /> �' ;i <br /> Date ,i �7 �y�� �,���:�•�o.�P�.,�,,. _� ,-'��;,- u� <br /> Omp �ea�.s__� J � .. <br /> qpplication For <br /> xr� PUBLIC WORKS PERMIT °°°To,aFe�`�� 5 -- <br /> '9 y iessaoot Fce ao�o s a� _ <br /> �O'.b C�"+ eawnce Duc 5 -�� <br /> a y y Print or Type Only <br /> rx> <br /> y z r�-i <br /> K ,�� �r ,��:..-' � �' riu ��0� �t//�4 l= �nrfi� �rF� � .?S�' —(l59 <br /> � H y�.� Ov+ner Mailing Atldress' Qty Zip Phone <br /> [/]H <br /> � z"� I''c, r�2, /'^n �� /nl� i��ux /�f- �/�P,24 3 :x 5' �'-S � i�- <br /> y ty Appiica� Madmg ntltlress Ciry Zip �hoce <br /> OH�y 1. <br /> q~j�pq Uescribe Proposed Work �� ' � � °`C�v� <br /> 9 H[+7 <br /> g "y . LL� <br /> � <br /> H <br /> �n �� � � <br /> r Prolec!Address(if known) � �S— E- � �/F9T'�'t �t�FJ� - <br /> Csl <br /> Z H Cn Aitad�four(4)copies of plans br proposed work� Drav;to scale and note Ihe follovnng as applicab�e: � <br /> y �� • Property Lines • Centerline of stree� /A <br /> • Ouiline and dimensions of all exisliny antl • Indicate North V� <br /> proposetl s�ruc�ures on�te Iot • Show any proDosetl gratling�hanges <br /> • ExiSiing and pwposetl,ddaics • Show mcasurements M <br /> W <br /> DO NOT WRITE B[LOW THIS LINE O <br /> PERId1T CONDI-fIONS <br /> �� t. Ati cails br inspection shaii be made 2a nrs. �n advance� phunc 259•881 5. �\ <br /> �� 2. All work shall be per�ormed in accordance with ihis nermil and c�rrent Ciry o� Everett Design and Consiruction ♦ <br /> Stantlards and S�ecifica�ions <br /> 3. Call Localion Underyround S'ervice 48 hrs. bebre you di9.TOLL FFlEE NUMBER 1•800-424-SS55. � <br /> �� � <br /> ..w. � �/ <br /> /. T,�F Souri/- er.Js�E,.��f/ f?�c���,�Ty Cvi���<=i� o <br /> f.c %./�S L�T �,�vsr 6'E .�ri?-t�-'p Tc L <br /> "� '� P.v����F Ty9T TiiE />,n�✓�=«.9f/ I��Ft ��a7 I� <br /> ��� �tiC.SS v,�c,�"' O�Uro GOT �2 . � <br /> � -r� O <br /> �w. �.J���.,�>i��.._..��/ �0.�'i�c:� /'7c'ST .5':� .�i�'t <"O W <br /> 0_ I <br /> ,_ � �j'F,<'c^i'�="- Ce�.t�e::�rE �.c' F�el�fld%�Ticit/ /S /�GL..Y_,�..-1J <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> -... � <br /> The undersi9ned owncr/applicani hereby agrees to hold and save harm� <br /> less Uie Gty of Everet� Iwm any and all claims lor tlomnges cosis, <br /> expenses. or wuses ol aclion �hat may arise Uecause of insfallalion <br /> � � i j�` ' and ma n�nance ol the irnprovement or other ri9ht�obway use hereto <br /> �.�{�� c-�� /n /!�y G anPl d for and furlher agrces�e-re ove same upon notice hom the <br /> Approved for Constructi � / Da�e Cit an to re lace public � ¢erly d. nageA Ihereby. <br /> D,�- �IZs�� <br /> FINAL INSPFCiION Dote � � I U 2� � ) <br /> Approoed as ConsVucled Signature of Apnlic,nt D e <br /> PUBLIC N'ORhS DEPARTMENT N'nRK AUTHORIZED BY THIS PERMh MUST BE STARTF_D WITHIN <br /> cverett 18U DAYS OF OATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> � 3200 Cedar Street 6E Dli ICENTLY PURSUED TO COMPLETION.THIS PEHMIT �AAY BE <br /> [verei!,WA 98201 CANCEU.ED BY THE CITY UPON ANY STOPPAGE OF'�VOPK ON THIS <br /> Phonc�. 259�8815 PROJC-CT OVER 90 DAYS DURATION. <br /> ` <br />