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�_ <br /> 3 <br /> � / <br /> /� �/�,� � <br /> 7�^ �a�e.�� /� Pu�l¢Work�Permit� � <br /> . <br /> Application For eiop Deo��• <br /> PUBLIC WORKS PERMIT P°°'�°"'°"_"° S <br /> � � Toialfee <br /> le5!>00���ee PeiE S <br /> y Baiance Due S� <br /> d M Print or Type Only <br /> ��" � �n�na �� �ox��� �UP� �-t (�2�p, 2 �-�S�� <br /> � ; � s-r G <br /> pjy�� Owner Maihng Address CAy Zip Phone <br /> '+tl N '�U <br /> UJ M <br /> ��� ApPlican� Mailing Address Ctly ZiP Phone <br /> � <br /> o � P� CP c-P Co.___s �c,��s 2- �v � oLv s��I n <br /> �y � Describe Pwposed Work <br /> M• ��1��( L�a - I �. -5 �-(r,.1 f S ' JS <br /> �y ll O � �( L �y �.of C , <br /> ~ _� f� U � 1 �� c �, � ' (p � C�/ F�L 'y l�P G�l�f0,c,�--� 1�{_�>�a�c(f c`a1 W <br /> tn <br /> �t~o ///'� {'Cf C�:' � � <br /> r Pwiect Address Iil known) <br /> �dl Atlach lour(4)CopieS ot plan5�or pwP�sed work• Draw Io SCale and nOte Ihe�ollowing as apUliCa6le: � <br /> �p • Property Lines • Centerline ol street � <br /> • Outli�e and dimensions of all existing and • Indicate Nodh <br /> propoeed SVuctures on�he lot • Show any proposed g�atling changes <br /> • Exisling and pmposed utililies • Show measurements � <br /> �-�" - DO NOT WFITE BEIOW THIS LINE O <br /> ��� PEFMIT CONDITIONS <br /> 7.All calls tor inspection shall be matle 24 hrs.in advance-phcne 259•8810. � <br /> i 2.All work shall be peAormed in accordance with this permit and current City ol Everett Oesign and GonsVuction <br /> Standards anA Specilications. <br /> 3.Call Location Underground Service 48 hrs.bebre you dig.TOLL FREE NUMBER�-800•424•5555. � <br /> i �� �l. !�S �✓ Publr-� �,I�ivks In��� drvr,`-�3v►�. � <br /> �� <br /> �I � � <br /> � <br /> �� O <br /> a <br /> __. <br /> . ACKNON'�C-DGF:MENT OF CONDITIONS <br /> �� The undersigned ownedapplicanl I�ereby agrees to holtl and s2ve harm� <br /> - less the Cily ol Eve�etl lrom any and all claims br d,mages, costs, <br /> /) e.penses, or causes o� aclion that may arise 6eCausr; ol ins�allation <br /> �l� / . Yvj� � � � �.L 1 �'} and main�enance ol the improvement or olher righ�-ol-way use hereto <br /> .' i, , _ Kf�i' ���/�� � applied lor and �urlher agrees to remove same upon notice Irom Ihe <br /> � ' '-� ' � ApProved for Consyti� tiou �a�� City and r place pubhc propert maged thereby. <br /> -r,�l`�1--�� �� " G' !�S •Ch--' �- � �i. <br /> FINAI INSPECTION Uate <br /> qpproved as Constructed ig e of Applicant Date <br /> . � PUBLIC WORKS DEPARTMENT �N RK AUTIIORIZED BY TIi15 P[PMI7 UST BE STAFTED WITHIN <br /> � 180 DAVS OF DATF PERMIT IS ISSUGD AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TG CGMPL[TION. THIS PERMIT MAY BE <br /> �T Everett.WA 98201 CANCELL[D BV THE Cil7liap�;ANV STOPPAG[OF WORK ON THIS <br /> Phone:259�BB10 PqOJ[CT UVER 90 DAVS DURATION. <br />