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% <br /> � ��11 �I �G� <br /> � '�° Date 2c) r��ei,owo,wsv�,mn. <br /> ro �'(/? 7�G,•l _ <br /> p � . Bi�g.0e01 • <br /> Application For <br /> C H <br /> � � " PUBLIC WORKS PERMIT `°°'"""°"„" <br /> To�nifee S <br /> M S <br /> �7 F� Lesa Ppo�Feo PaiU $� <br /> 1� � �Q�� <br /> Bamnta Duc $ <br /> � � H Print or Type Only ~ <br /> � � � ,._ �>c?-1��•-yc�-nno-i/-ssi <br /> `° � � � / � . _ •. <br /> � � - /30 � �'Jc �ill �. �v��relj 9k1'. 03' ���3-l0/�l(� <br /> ~ � Owner Maihng AddieSs � � � . City Zip Phone <br /> N ` � _. c ::� }�5� �1c, �/97 <br /> � H ��1�[ �Clll51 �� ��L � �������1\� � �����1� �� ����-��l/11� ���G� l�� ����� /��� <br /> y qpplicant Mailing Address C�ly ZiP Phone <br /> F+ <br /> $ p N <br /> [y;j �y � Describe Proposed Work ����� � � �"� �1 ,(��� �� <br /> y p N <br /> W <br /> . , .. _� ___,,k , r3o f f1� T � ► � �-- <br /> Attach four(4)copies ol plans lor proposed work-Draw lo scale and note ihe lollowing as applicable: � <br /> • Property Lines • Centedine ot street � <br /> • Outline and limensions of all existing and • Indicate North <br /> proposed stmctures on ihe let • Show any p�oposed grading changes <br /> • Existing and proposed ulilities • Show measuremenls M <br /> W <br /> DO NO7 WRITE 8[LOW iHIS LINE O <br /> I� �� PERMITCONDITIONS <br /> C� 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 Ciry ol Everett Design and Conslruction <br /> � � � Standards and Specilications. <br /> 3.Cali Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1�800•424•5555. � <br /> � ' <br /> � _— � /� O <br /> � �^���ti=f N��tr��A' <br /> / v--v�coc �' "y— <br /> � ��.1 r��T-- ---�1 A <br /> N� <br /> .,.> O <br /> .� ,/ rm,: �-�r�.�� .sr- <br /> � 1 � 7 /7��«f�.ti.n�.w' r _,t�,r c�i�.r,��✓�f <br /> �$'/olC jC f/� ��;f�.r,.c;�,�.f y o:�� fi;�' Cz�_r�',-.- � <br /> a �_� � <br /> � <br /> ACKNOWLEDGEMENT OF(;ONDITIONS <br /> ' The undersigned owncr/applicant hcreby agrees to hold antl save harm� <br /> less ihe City ol Everett Irom any and all claims for damapes, costs. <br /> expenses, or causes ol aclion Ihal may arise because of installation <br /> � ���� ����� %,..�`� � and maintenance of the improvement or olher righbol�way use h�r�to <br /> �'�� �Y< apPlied tor and �urlher agrees to remove same upnn notice Irom �hn <br /> F.pproved �onstruction Date ���y and r,place public roperty damaged �hereby. <br /> � .1�� �� ,�- i���� <br /> FINAL SPECTION � � Date Dale <br /> Appmved as Constructed Si iature ol ApP���ani <br /> � WORK AUTHORIZED 6Y THIS PERMIT MUST BE START[D WITHIN <br /> PUBLIC WORKSDEPARTMENT 160 UAYS OF DATE P[RMIT IS ISSUED AND TH[REAFTER IS TO <br /> 'V� 3200 Cetlar Sireet O[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> EvereU.WA 98201 CANC[LIED BY THE CITV 11PON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�f3810 pROJECT OVLR 90 DAYS OURATION. <br />