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. .. - . . ._-� r <br /> n <br /> ���.,/� °""� �", S y- 3� <br /> Date-1��LL� I ' r�oi��wo,�.srP,m,�� ��j,�}��_��� <br /> AppliCation For einy Dnci • ' 1 '��_ <br /> PUBLIC WORKS PERMIT P�°��°w°��°�re -- - <br /> ro�r�Fe� s <br /> lessAn���ine Pa�a 5_ <br /> � �y Print or Type Only ea�T�«o�,• a 7/`-�n <br /> O �pC <br /> H�� �h�l 1 ��m )h� ,-�1��l- {-��'F''F� �1. I �l�" `��z��`-�� <br /> � Ow er Mauing Atldress Cny 2ip Phone <br /> MC C1 <br /> ��� i o ��-�n✓ � (�DX �f1 � �ni�,�� ����i� �l�-�838 <br /> L <br /> �p.� Applicant Mailing Atltlress �ty Lp Phone <br /> X <br /> O qy d Descn6e Proposed Work �'���� <br /> N [9 <br /> Qr <br /> xy W <br /> �� Pro�ect Atldres5l�l known) j��� ���Y ��\� — � <br /> N <br /> ',,y W Atlach lour(4)coPies ol plans lor p:oposed work- Draw to scale and note the lollowing as applic3ble�. � <br /> ��� • Property Lines A Cen�erline ol street /A <br /> • Oulline and dimensions ol all existing and • Intlicale Nor�h V� <br /> �� proposetl 5tructures on Ihe lot • Show any proposetl grading[hanges <br /> • E+�slmg antl proposed utilities • Show measurements � <br /> � DO NOT WRI7E BELOW THIS LINE O <br /> PERMI"(CONDITIONS <br /> I, i.All calls lor inspection shall be made 24 hrs.in advance-phoue 259•8810. � <br /> C 2,All work shall be peAormed in,iccordance wi�h this permit and current City ol Everett Design and Construction <br /> � Standerds and Specitications. <br /> 3.Call Location UnCergrountl Service 48 hrs.baforp you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> I � CrYld�� qt /C.'�c'Yl��?�j 7+:�:..J ���;l.��' r2Ll�7�� �Ci. tL :7/ .�':� O <br /> I ��� .l.L�2a� ^'.�! �.iaF �< ,/�i� ��94 jGl i �G7Lf�-r7r 7��%�>ic/'I_�C' . <br /> , �%�?7/.'-i ,Ln.�_EC C�✓ � iGrr7/ ��lG^.- �„� �n-.4�C.�C<�� .QCrr,<<. � <br /> �% <br /> ,_�1 ��,� �/Zc�«..tr >-y !�!�i_L���, ♦A <br /> � �- ' ✓ O <br /> �- a <br /> _� <br /> ��y ACKNOWLEDGEMENT OF CONDITIONS <br /> �� �y� The undersigned owneUaoplicant hereby agrees to hold and save harm� <br /> _ . less the City ol Everett Irom any and all claims �or damages, cos�s. <br /> ezpenses, or causes ol aclion that may arise because of inslallation <br /> � �� G�� /-p— � �_ �4 and mamlenance of Ihe imprOvement or o�hr.�r righl-ohway use here�o <br /> ���� ��" L applied for and lurther agre s to remove s�me upon notice Irom the <br /> Appmved lor Construc ion Date Cily d to re ublic pto erty tlamaged thereby. <br /> � FINAL INSPECTION Date � c� � `�� <br /> Approvetl as Constructed gnature ol Applicant Date <br /> everet[ PUBLICWORKSDEPARTMENT WORK AUTHORIZED BV THI PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSiree� 780 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PFOJECT OVER 90 DAVS DURATION. <br />