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�'�._._. '- <br /> ,, <br /> ���.9 <br /> F�.'� d <br /> & <br /> >y <br /> i <br /> �r.<'z <br /> M `.:r. <br /> ,LL l�^� <br /> Y � <br /> ; ^ �y roou�wo�w.v��mn• <br /> Date BICp Oeot��I d 0 S` <br /> � Applicalion For <br /> PUBLIC WORKS PERMIT runTol�fee`ea s <br /> �^y . ie�s�no�ree ram 3 <br /> fi <br /> a B�I�nce Due f <br /> �p�x Print or Type Only <br /> >yy � <br /> H �7t • , �� ,J� ia� 7 �i��,t:L� Y�'2o L � sP-7 Zi <br /> k y� � Owner Meiling Address Cily Zip Phone <br /> �y� ; • �' /�OG_ 'f� �*'` �y�>,ea � y1P� ypie,� 61/ - FLi7 <br /> r�._.� <br /> .lo A plltenl <br /> Mailinv��dress Cily Zip Phone <br /> H C7 �J <br /> Describe Proposed Work <br /> L/ -•,..� �.i 1 �«,7' <br /> Q�g - <br /> �yH� : u <br /> t" y <br /> r�H • � <br /> � y J!O O ' . <br /> ~ Prolett Address(il known) <br /> N , <br /> � <br /> C'� . Altach lour(4)copics oi plens lor p;oposed work-Draw to scale anA nolo Ihe lollowirtg as apP�icable: � <br /> �]t�� • Property Unes r Centerline ol slreel <br /> y • Outline and dimensions ol ell existing end • Indicale Norlh <br /> H Q V� � • Show any proposed grading changes <br /> ._ proDosed siructurns on Ihe lot � Show measurements � <br /> , • Exisling and proposed utilities <br /> ; DO NOT WRITE BELOW THIS IINE / <br /> � <br /> � PEFiM1TCONDITIONS � <br /> ' 1.All calls lor inspecllon shnll be made 2A hre.In ndvance�phono 259•88�0. <br /> ' 2.All work shall be pedormed In accordance with this permil and wrrent City ol Everetl Deslgn end Consimclion <br /> '� � Standerds and Specificatlons. <br /> �� . 3.Cel�Locelion Underground Service 4B hrs.6elore you dig.TOLL FREE NUMBER 7•B00•424•5555. � <br /> ��. � � i�,��� ��- �-�.,ti� ��� ��2.����0 � <br /> . �. U- ��- 9� r <br /> 1� �' � , <br /> � � �� �� ,�„/ s���?fl <br /> � � r�l� cvaz.� ���ti^�`Y / <br /> �� � �(.��co c.J��/tR.ucccr> ��r-�-' a- �}�"'.f C'°.r" '`c� ` <br /> ""� ' .37`1/ �H°�,J , � � �i..ei � C� <br /> � ,C�_c 7�+a-�i 2r/°""Ca.l��-�. <br /> � � � <br /> ACKNOWLEDGEMENT OF CONDI110tJS <br /> � � i The undersigned owneqopplicant herehy ngrees tc hold and save hni <br /> �' ' less the Cily ol Everett Iwm any end all clwims Lr dameges, coe <br /> � eapenses, or causes ol nctlon Ihat may atlse becnusa ol in;lellati <br /> and mainlenance ol Ihe impwvement or olher tlghbobway use hen <br /> evP�ied lor and lurlhcr agrees lo �emove same upon notice Irom 1 <br /> '- �� Approved lor Conslruction �fl�e City and lo replace public properly damaged there6y. <br /> i Dale <br /> fINAL INSPECTION Si6nalwe ol Apnlicant Dale <br /> ' ApP�oved as Consiructed <br /> WORK AUTIIORIZED BY TIilS PEFiMIT MUST BE STARTED WITI� <br /> PUBLICWOPKSDEPARTMENT 1B0 DAYS OF DATE PEfiMIT IS ISSUED AND THEREAFTER IS � <br /> . , �'� 3200CederStreet BE DILIG[NTLY PURSUEO i0 COMPLETION.THIS PERMIT MAY ' <br /> Evercll,vYA 99201 CANC[LLED BY 11iE CITY UPON ANY STOPPACE OF WORN ON 71' <br /> � PM1onn�.259�8810 PROJECi OV[R 90 DAYS DUMTION. <br />