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.� ......�_ - <br /> • � r .i. (� � p <br /> Date���— � J �� PuhLcWoa�P�rmil• _J��Q•�—__ <br /> Applir.�tion Fo� q e��+n oeo� , . _—_. <br /> in <br /> PUBLIC WORKS PERMIT � ���°°��,°°��t�°° - <br /> ,��.,��,.� s <br /> Q 1�•55 4p01 Fnn V:�i:l �J` <br /> PriM or Type Only � � � �A�,�,��•n��„ 5_,�O '� _ • <br /> � � �oz -34z40/i�4_3/ 3 4- 41 <br /> il. °' � , , �, P�� <br /> KP� ����,��,I�.c ��y�.. � � �� . NF _�-�. I.� � �� ss � � . � �� � _ <br /> Ownei �9a���r,�Add�ess C� � a. lin Phnnc <br /> S�,�_� N ✓-1 W <br /> �nt�, ^ ' / � �-T_ � �� �L Cfi i - --- <br /> �l�L.__�Q__E_�CtiY I � ,a�h� -�------- - <br /> Apphcan� Pf:��6n;7i1tldi��ss Citv Zip -�--- P!mrn� <br /> Desr,ribeP�opose_fWork _.11_1����-.���-. —.��-5_P��l_'�/���J_,"'�-���/- ��3rz�tl_��Z_'-- <br /> _ (y. �_(„����, ���_r►'Sta__S.���t---�Z- tv` r �[-r,n� _ (timn cM.�_._ <br /> d r �� I. i c,� _�-o _L�J� ror� ��-�.�-:���—,��'��_�r—7— <br /> f�'II -�__r�1.r�i�._ ����1 s.��-�,`f-,---�-�—ry�-- W <br /> ProlectAddressl�lkn�wn! _�-�._E_._/V1(��'LI11.h._/�7.�'4.__._—.`-�r�'��—�Lv��1 ��� � <br /> 1 _.. <br /> A�taCii�our 141 coPics ot Plans lu� nroPosud w;r. � D�ov: ta ,�-.,ib�.c,.i nnt.r �hc'aio�.ving a:; anuhcahie; � <br /> • P�operty Lines • C��nleri�nn �i; 5treei � <br /> • Ou�line and dimensions oi aii exist�ng ancf • Intlia��^ Norih <br /> proposed slruclures on ihe lot • �hovi any r.rnposed��ratl�n�� chnnges <br /> • Existin9 and proposed utili(ies • Show mnasuremenis � <br /> DO NOT WRI1�E BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspectian shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> /' / - ACK'aOIVLEDGEMENT OF CONDITIONS <br /> i n���md��r��qned ovr.ie�iapphc�nt hereUy agrees to hold and saee harm� <br /> � ir,.�: ;hr Gty ot [ve�el� 'rom any enn all c�aims lor damages. cosls. <br /> �J ; e��t��'nses o� causes ot action Ihai may anse because ol mstallation <br /> �i., /%_ { q'/ and �naintenanr.e n� Ino improvement or other righl-ol-way use here�o <br /> ' i u ��i C'C'7"��-- / �� /l- i �pp�,nd fer antl turihr� an��es lo �emove samr. upon nofice Irom Ihe <br /> App�oved f nstructi p D�Je I �,!y ar.d to replaCe PubLc properiy damaged �hereby. <br /> / i /�' <br /> ' j L�e���.,r-l'� �-- Z3 -9 S <br /> FI INSPECTION i�� <br /> Approved as Conslructed I S�gnalure o� plican! ���� <br /> � PUF3LICWORKSDEPARTMENT I INORK AUTFIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> I i90 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarSPeet � 3E DILIGENTLI' PURSUED TO COMPLETION. ?HIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 I PRO.IECT OVER 90 DAYS DURATION. <br />