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l•J [i � <br />>H <br />�azx <br />a Hx cF'n <br />H^�3 <br />y 7H <br />�C C� <br />H x1 <br />'+] H '�J <br />V1 H <br />y r <br />� o r� <br />HO <br />ON <br />77 C) C7 <br />F/,� C�7 O <br />y�Y C] <br />iH� <br />ryz <br />r-� y <br />gy <br />H <br />C� C7 � <br />��r <br />z �-3 c�n <br />H O Cn <br />D a t e. _L � ��� �D <br />FnpLr;il:cn f-o� <br />PUB�IC WORKS F�ERMIT <br />Print or Type Only <br />G� <br />����1 <br />APplic2nl <br />Descri6e Proposed Work <br />Pro�ect Address (if knewnl <br />Maihng Address C�ly Zip <br />.-„���,� ;, .� .. r,.,�,�•�] ^� 2 <br />��no orni . —E�—l-�ll!.1�cJ(��- — <br />��UIII�C WO�MS FCB <br />,o�.,� «� s _. <br />1ns54r0i Fnn PnN S — <br />I�a.an, r Ou� $ <br />Attach inur �:1 copie5 of planS �or propOsetl worA � Drav: to sraie anA nole �he following as aii; •licable� <br />• Pronerty Lines • Centmline ol street <br />• Outl�ne ano dimensions ol all es�sl�ng anci • Intlicate North <br />n�oposed sirucWree on ihe lot • Show any proposetl 9mdiny chanyes <br />• Exisbng and p�oposed utilitics • Sho-.v measurements <br />Phone <br />Phene <br />PEFMIT GONDITIONS <br />L �i� calls for inspection shall La made 24 hrs. in ativance - phone 259•8810. <br />2. A I work shall be per(ormed in accordance with ihis permit and current Cily of Everett Design and Construction <br />Siandards acd Specilica�ions. <br />3. Call Location Untlerqround Servic, 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />/% �[ - � .� <br />/ �'4 �•i;`_ /C. .'�/_ /� :��: --� ��1�.'� ,�.��.2� .,.��'� <br />toi Consi�ur.tion <br />/ <br />_. �,� . �. . , • . �. <br />�� <br />3-� 16 <br />W <br />� <br />//�w <br />_ / <br />Z <br />O <br />�w <br />_ I <br />O <br />a <br />ACKNOWLEDG[td[NT OF CONDITIONS <br />The undcrsigned owner/appGcani hcreby agrees �o haid and save haim� <br />Iess Ihe Gty al Everett iram any and all claims fer dama�es. costs. <br />eapenses. or causes ot acllon thal may arise because of installation <br />and maintenancc ol Ihe impiovement nr other right�ol-�vay use hereto <br />❑ppueA lor and lurlher ag�ees to remove same upon notice Irom the <br />���� City and to �eplace public Groperty damagetl ihereby. <br />FINAL INSPECTION Dale — <br />Approved as Consiructed Si9nalwr, ol Appliw�t Date <br />WORN AUTHORIZED BY THIS PEHMIT MUST BE STARTED W�THIN <br />��vcretl PUBLICWORKSDEPARTMENT iti0 CAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />� 3200CedarSlreet BE DIVGENTLI' PURSUED TO COMPLETION. THIS P[RM111T t�4AV 6E <br />Everet6 N'A99201 CANCELL[D BY THE CITY UPON ANV STOPPAGE CF WORK ON THIS <br />Phonc�. 259�8Bt0 PROJL.;T OVER 90 D�1YS DURATION. <br />