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f � <br /> 1 <br /> ��� <br /> H <br /> t"xH C/� . ,.. <br /> H x� . �_.._—�—___� . . �� ,_. —'� <br /> —-. -- -.-^—'�--'--4. <br /> �y� � . .. , r�r <br /> o rsr <br /> �d H� ' :l. 1 . � . I � <br /> ��'y �/ . �PubLc Wo�kaPe�mY.� ` I <br /> y n � Date ' �- � �� � _ <br /> Biag Deo��• <br /> �y�jr I qpplicalion For <br /> pUBLIC WORKS PERMIT P°°'"'"°'""°° s <br /> O 1-3 rJ TatalFce <br /> � � �J I less PDO�Fee Vai� S I <br /> �r c� BalanCeOUC 5 I �. <br /> sH� I Print or Type Only 1 ' <br /> r, y ' <br /> gy� �Ti�� t `I l�a'��`.� �C. I�[� i 11 Y'r �t��� Yi �"i,��� ���,�'zG 1 ��'!� -:�SS'C i <br /> C] �'J tA Madm9 Adtlies CnY LP �Phone � <br /> ❑g Owner � I <br /> 3C1 � , / � '-' I 1 <br /> ��y� =�' (�' %/IVa H7/� % �1�� 1-��`LC', Y'1, —��r�' 9���� ��2 k'�LZ� �i i <br /> H p y i L._. CitY ZiP Phone <br /> � qpplir,ant Mailing Atldr 55 <br /> ��fG%�iG� i <br /> � Describe Proposed Work I I <br /> i <br /> �I � <br /> W ', � <br /> Prolect Address lif known) � i <br /> � � <br /> Attach four(4)copies ot plans lor proposed work- Draw to scale and note Ihe lollowing as applicable: � i <br /> • Properly Lines • Centerline of slreet i <br /> • Indica�c Norlh <br /> • Outline and dimensions ol all existin9 and � Show any proposed grading changes <br /> proposed siructures on the lot • Show measurements M � <br /> � • Existing and pmposed u�ili�ies W <br /> � � � � DO NOT WRITE BELOW THIS LINE � I, <br /> I <br /> I '�' PERMIT CONDITIONS � � <br />� 1.All calls for inspeciion shall be made 24 hrs.in advance-phone 259•8810. <br /> j '�1 2.All work shall be pedormed in aroordance with thls permit and current Ciry ol Everett Design and Consimction ,I <br />; Standards and Specifiwlions. � <br />�� '�' 3.Call Location Undeiground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. i <br /> �—'�,'C���IC. \VOK.1=`,.> Y�:�L.M�r N�.T Kt4v�C� V <br />, 1 �— �j ' `�C O �I. <br /> ' I <br />` �-«.�A.. �1 � ' �c-`'L � I <br /> f I <br />, �; � � � <br />� _ o <br />� ►_� ' a I <br /> � � <br /> _ <br />, ' ; ACKNOWLEDGEMENT OF CONDITIONS �i <br /> � The undersigned owner/appliwnl herehy a9rees to hold and save harm� <br /> ---- less ihe City ot Everett Iwm any and all claims lor damac�es. costs. <br /> expenses, or causes ol aclion that may arise because of installation I <br /> and maintenance ol Ihe improvement or other righPol�way use herelo <br /> applied lor and lurther agrees to �emove same upon notice ��om Ihe <br /> Approved for Construction Date City and to replace public properry damaged thereby. I � <br /> Date Dat� � <br /> FINAL INSPECTION Signalme ot Apqlicant � <br /> ApprovedasConslrucled WORK AUTHORIZED 8Y THIS PEFiMIT MUST BE S7ARTED WI7HIN I <br /> I everctt PUALICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 1 <br /> O 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BG �, <br /> � Everelt,WA 98201-- - --- CANCEILED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS i <br /> Phnne:259�8810 PROJECT OVER�JO DAYS DURATION. <br />