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rv�^cT,ao_,—�a-.yr,.Re..�_.-�: `�..�w�—'.-�..�s-+.mc+�.-.+�a�+.�.�.. . ,.'... .. '7.,;�:^i^��.4i'�1. � . - f;'iin..^y.�- ��--'+'- ry <br /> �a�e�� a�� � Pu�Lc War4e Pe�m��� � I <br /> / / Biaa Deo�.• - <br /> . qpplication For <br /> PUBUC WORK� PERMIT P°°;aWF�°` s -- <br /> le nol Fee Pa�C s <br /> Balance Due f <br /> Print or Type Only �� <br /> Owner MadingAddre:s City 7�P Phone <br /> `�� I��o� �a � e�P �(��l a ac�` ,p St.S�,���.�,��+ qg�o y� -z�s� <br /> Applicant Maihng Address City 2ip Phone <br /> Describe ProposeA Work � �"" �'` -- -- <br /> - � �� _ W <br /> Prolect AAdress lif knownl �--��� ��' C�, �`?-yl�— '� ' ^ � <br /> Attech tour(4�copies ol plans for propo<e.d work� Draw to scale and note thr,followinp as applicatle: � <br /> • ProPeny Lines • CenterM1oe of street � <br /> • Outline and dim?nsions ot all ezisNnC and • Indicale North <br /> proposed siruUures on the iot • Show a�iy proposed grading changes <br /> � Exisfing and proposed utilities • Show v�easuremenls � <br /> DO NOT WRITE BELOW THIS LIi�G O <br /> PERMiT CONDI'IONS <br /> 1.All calls lor inspection sh211 be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work ahall be pertormed in accordance with this permit and current City of Everetl Design and Censtruction <br /> Stendards end Specifications. <br /> 3.Gall Location Underground Service 48 hrs.before you dig.TOLL FR�4E NUMBER 1•800�424•5555. � <br /> � �'� � o � ,C/J/i�95 c//f�/�e� /� c�`�//C�`� O <br /> �GrTi/f��s ��'� - <'`�- �L`�� �/�.P����,� � <br /> �.E'��95 . �/r/C'.�'�L'/f��=� //vJ� Y♦ <br /> ,,� � . � . ������� �� �=� �, ,-y �v,� o <br /> �u.��J�' ._ a <br /> ,�'� _ � <br /> � L,9/I��� ��'/��/!�� �'��:%/.�_'��J <br /> ; ✓ �'G <br /> /^ )����G ��`/� ��?r/ ��a�ACKNOWLEDGEMENTOFCOND'fIONS <br /> ��� � Th undersigned owner/applicant hereby agrees to hold and save harm- <br /> — ' Iess ihe City ol EvereU from any and all clai�ns for damages, costs. <br /> .���7 � .] ' � expenses, or causes of action ihat may arise because of insiallation <br /> � d maintenance oi ihe improvemenl or uther nght�o4way use hereto <br /> � �� I <br /> a i an I rther agrees to remove same upon notice Irom the <br /> Appro tor n;tfiidio� Dal ity a t p public property damagrtd Ihereby. I <br /> FINAL INSPE/N �a1e ' /y ' 1� <br /> Approved as Consiructed Sign ture 1 A plica t � Date <br /> WORK AUTHORIZED Y THIS PER IT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS IS: UED .'1ND THERFAFTER IS i0 <br /> � 3200CeCarStreet BE DILIGENTLV PURSUED 10 COMPLETION. T�IIS PERMIT MAY BE <br /> Everett,WP 98201 CANCELLED B'i THE CITY UPON ANY STOPPAG'c OF WORK ON TH�S <br /> Phone:259�8810 PROJECT OVER 90 DAVS DURATIOIJ. <br />