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� . ,, ,-:. �, .. � � <br /> . - .. �., .ti.,�. .�� .-, . . , <br /> .,, • ' <br /> , r <br /> �8t9 /'!•/I�/tg WEIitWor4MrmM• <br /> . BMY.D�GI.e <br /> Applkation For <br /> PU$LIC WORKS PERMIT "'°'K"'°�."' <br /> Tb.�Fea • <br /> La0 Appl Fae P�IG s <br /> B�bnce Due S <br /> Print or Type Only <br /> �S,CsT,9�1c� LEAGOE /g�6 11El�fT AVE• EYEtETT <br /> OwneA MeiNng Address C�tY Zip Phone <br /> ,L <br /> l�-s��,v r�u! ne�r,�naa,, r • ��� �� a?es A� �c/� A,�l.�>zr.�c-, ,cw ��o �s2- �z r � <br /> Applicant � Mailing AAdress Cdy Zip Phone <br /> Describe Proposed Work A�T�r� ���1�J!✓� � �/Srik,( �i/�E Sf A�!/X. <br /> �� � Nifi/ �dica/a� . •i�u_ �,�ttl T c��.� _t,r.,.r S .�cxO,c. .�c }� T'o <br /> �` `` W <br /> Prolect Address(if known) �7� � /��� ��//r� �vE — � <br /> /I� ' � <br /> Attach tour�A!copies of plans lor proposed work•Drew to scale und note the following as applicable: � <br /> • Property Lires • Centerline of streel <br /> � Outline and dimensiona of all existing and • Indicate North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDl710NS <br /> 1.All calls for Inapection ahall be mede 24 hrs.in advence-phone ZS9�8810. � <br /> 2.All work shall be peAormed in accordance with this permit end curtent Clty of Evarett Deaipn and Conatruction <br /> Stenderds end SpecHicationa . <br /> 3.Cell Lxation Underpround Service 48 hrs.before you dig.TOLL FAEE NUMBER 1•800�4245556. � <br /> � � �t���f�� <br /> .,F— z3 � � ���' �'�'' � <br /> , Q +� °y'N,ou�,�.�. L'c,�ru.�i�-wO� I... <br /> _ ' � � � <br /> ' � - - - - - - - - - <br /> _ . _ . \\rc_A�, af n,a..r _ ' ' � <br /> / � � ��n' O <br /> --.� —CONck E"?"� - -1 Z i-- l,�A ck -----_"_ '�c y�s�l � <br /> � u��l'�- a <br /> � �Ou�Rf�E � �"-- <br /> �-- - - y -- --- �- <br /> r <br /> sT�cEt? Cuc6 � ACKNOWLEDGEMENTOFCONDITIONS <br /> The undersigned owner/epplicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all cleims lor demegea coata <br /> ��//��� (//��� � expenses, or causes of action that may �se because of installetion <br /> 1 \w`"v"%j /-a 3 -�b and maintenance ot lhe improvemenl or other right•o4way use herelo <br /> � applied tor and further agrees to remove same upon notice irom the <br /> Approved for nstruction Date City and to replace public property demaged thereby. <br /> /2 S! <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of A plicant , ate <br /> WORK AUTHORIZED BY T S PERMIT MUST BE STARTED WITF!IN <br /> everett PUBLICWORKSDEPARTMENT iB0 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAY BE <br /> Everett,WA 9B201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATiON. <br />