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€ <br /> Date�c��l.lii' �� ���,�,��:��,",��,,���� _ - - - <br /> c�.;i n�.i:i • _—.��i'_�I��s—. . <br /> Applic�tion For <br /> �n� PUBLIC WORKS PERMIT V1To���caFee 5 <br /> 'a y Less Aoo�Fee Pn�G 5 <br /> ;y� TO POSTIPZG__ — ���,�_���� 5 <br /> y Print or ?ype Only <br /> y z��-+ <br /> o �o '�'u S .�o�n �c d3D9 (?a/c�s J� 1-✓Piptf- l�zd1 oZS'�' - �%679 <br /> � ~� Owner Maihng Address Cdy 2ip Pho e <br /> yyCg <br /> � O[�1 - <br /> O H� DAPPlicant Mailing Address CiIY ZiP � Phone <br /> � �,g �s�a�Y3__�_G�l�r�--� tf � <br /> c�� o l�u� ci»� d- P,1' �au� OK <br /> f-1 q Descrit�e PropoSed WOrk <br /> Y H3 �,t c�c v�S � � J <br /> � <br /> t r+H <br /> `� WH <br /> �C'] pC7� (�' <br /> xj "-(riy PwlectAdtlressl�lknownl � �b7 OQ�����—��- -- � <br /> zym � <br /> H O� Attach four I:I copies ol Plans b�Proposed work� D�ar: In sc:��br„nd note the lollowing as applicable. <br /> • Prcnerry Lines • Centedme of strect ♦^ <br /> • Outime and dimen5ions of all ev�:hnq nn • InAicale Norih V� <br /> proposed struclures an Ihe lot • Show any pronosed g�admg chan�es <br /> • [xislmg and proposeA Wihhes • 9iow measuremenis /� <br /> W <br /> � DO NOf WRIT[ 9ELOW TiiIS LINE O <br /> w.� PERMIT CONDITIONS <br /> � � 1.All calls lo�inspection shall be made 2d hrs.in advance�Phone 259•881 O. � <br /> 2.All work shall be pedormed in accordance with Ihis permil and curtent Cily of Everett Design and Construction <br /> Standards and Spr,cihcalions. <br /> �� �� 3.Cnll Locntion Untleryround Serv�ce aP hrs Ucfore you di9 TOLL FREE NUMBER�•a00•4'14•rJ$55. � <br /> � ' O <br /> .�.� �.'��cC: (4,1c-Z.l�:l.r />(�-�i,+,�.� /L/„/ .L�"y�c<c �.r ���� , � <br /> �a�eC��-� _ <br /> ��� iz- ��o � <br /> � O <br /> ��� a <br /> i " <br /> ,R' � ACKNOWLEOGEAILNT OP CONDfiIONS <br /> The underv{�netl owneqapplitanl hereUy at��ees lo hold anci savc h0nm <br /> less Ihe Cdy ol Everett Irom any and all claims lor Aamaqes, cosls, <br /> expmises. or causes of action Ihat may arise Uecause of installation <br /> antl maiNenance ol Ihe �mp�ovament or other ri�hPol�w[ry use hereto <br /> �pplicA lor and lurther a9rees to iemove same upon nolice irom ihc <br /> Approved loi Conslruction Date Cdy and to replacc public property damaged Iherehy. <br /> FINAL INSPECTION Date Oate <br /> Approvetl as Conslructed Si9naWie ol ApPlicant <br /> WORH /1UTHGRIZED BY TI115 P[RMIT MUST BE STARTEU W�THIN <br /> i.��•�i.�� PUBLIC WORKS DEPARTAIENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DILIG[NTLY PURSUED TO COMPL[TION. THIS PERMIT M11AY 8E <br /> Everel6 WA 98201 CANC[LLED BV THE CITY UPON.1W�'S70PP�1GE=OF IVORK ON 7HIS <br /> Phone:253�0810 pROJECT OVGR 90 D�YS DURl�IION. <br /> 5 <br />