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! <br /> ��� <br /> A� x . <br /> C, H <br /> H�� <br /> fC C� <br /> 'il H� , <br /> y � Date'� Zy90 ' 2�f�1(oZ <br /> y Puo�¢wo�As Pmmn+ <br /> Application For eiaa ocm�•— <br /> � " � PUBLIC WORKS PERMIT - <br /> O� PuEuc Wade f ee g <br /> ��� Tot.�i ice <br /> �V � Lese/pP�..Fee Pai! $ <br /> �H� 9aianee Duo S <br /> y Print or Type Only <br /> �+ H <br /> N Ec,�p�2�� Sr1�oa�P <br /> ��y l��f. .339- yzzb <br /> � Owner Mailing Adtlress C�ty Z�p Phone <br /> H O vwi /�/4 C�/SorU ��i_�n.�'••,�+ /��2.E��YI �'C�Lc.ZfccL�y 2 S8— lo S� / / <br /> Applicant Id�/n9/�.ddress Cuy Zip Phone <br /> � Descri6e Proposed Work � �OZ't 4 �J'��l C`v1'�v'ti°""�d=-- <br /> _ W <br /> Projecl Address lil known) ��� -P��� ��� - � <br /> httach lour(4)copizs of plans for proposed work- Draw lo scale antl note the lollowing as applicable: � <br /> • Pwperry Lines • Centedine ol streel ♦^ <br /> • Outline and dimension5 0l all ezisling and • Indicate Norih V� . <br /> proGosetl simCtures on the lot • Sho�v any proposed 9iatlin9 changes <br /> • Existin9 and proposed utililies • Shuw measurements Y <br /> ' 1 rii <br /> '—' DO NOT WRITE BELO�N THIS LINE O <br /> PERMITCONDITIONS <br /> '�' 1.All calls lor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ot Everett Desi9n and Consiruclion <br /> ' ' Standards and Specilications. <br /> � 3.Call Localion Under9round Service 4B hrs.6efore you dig.TOLL FREE NUMBER 1•S00•424-5555. � <br /> il 01_I ��.���r�a- �. ��-� �'�- Q. ��� <br /> �, � .u�iCC� .c�o>�s�rDt-�.C�ti lvaz/� .�co � <br /> ; '� � {� S�ro! . G�cc+C� -�w�f <br /> 6,e�"� �,��,,,�'� �a�c�, .�- V� <br /> � �� .� Cvaz�u�e/r,„�,,�.t'�Ua� ���. <br /> �� � � <br /> 1,�1 ��-20 � a <br /> ''1 ACKNUWLEDGEMENT Of CONDITIONS <br /> � The undersignetl ownerlapplicant hereby ag��es to holtl and save harm� <br /> —� less the City of Everett Irom any antl all claims lor damn9es. cosls. <br /> expenses, or causes ol action lhal may arise because ol mslallation <br /> and maintenance ol the improcement or other nghPof�way use hereto � <br /> _ applied lor and lurther ac�rees lo remove same upon notice �wm the <br /> Approved for Conslruction ��e City and lo replace public properly damaged thereUy. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Signawre oi Applicant Date <br /> WORK AUTHORIZED B1' THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT �i 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT t.1AV B[ <br /> Evcretl,WA 98201 � CANCELLED BY THE CITY UPON ANV STOPPAGE OFbVORK ON THIS <br /> Phonc:259�eB10 PROJECT OVER 90 DAYS DURATION. <br /> � <br />