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F" . <br /> p <br /> � <br /> ti <br /> Pupl¢Wdks Fa�mil a / O ��'�L' / �� <br /> Dale�Cp n,, �����_ <br /> / ' o��o oen� • _�(L� <br /> Application For <br /> PUBLIC WORKS PERMIT P°°'�°W°"„�° 5 — <br /> H Totri fce <br /> �y�� lCis A00�Feo Fa�d 5 <br /> `•'�y a,�,�«o�,. 5 �n �� <br /> C H Print or fypP Only <br /> a H V� <br /> H �3. <br /> � " �.� �.���1t- lana� -�S �L=--��%�T� <br /> � <br /> O CC O ����� Mailing Address City Zip Phone <br /> � fA H � <br /> � Xp3 ,Appli��� Mai��nyAtldress Cdy Z�P Phone <br /> H C7 _A � /1.� ��(1� ,� <br /> s,�<ylp ��H,ly n����.0 <br /> H/� [�iy p Descrihe Proposed Worh ��yt 1 - -/'M`��f' ��r�� =`�—I <br /> y�Y � <br /> r H� W <br /> y <br /> H 9Z — �,��S�`- �. <br /> � �� Prole��Hddress iil knownl /`J � ���` �" <br /> [�l Attach lour(4)copies of plans lor proposed work- Drac: to scale antl note Ihe lollovnng as apPlicaFie: � <br /> y0 y • Property Lines • Centerline ol slreel /^ <br /> • Oulline and dimensions ol all eaislin9 antl • Ind�cate Norih V� <br /> proposed slruclu�e5 on Ihe lot • Show any propOSeA�radm9 chanyes <br /> • Existin9 antl propo,etl utilities • S�',cw measuremems 1���q4596 � <br /> DO NO1 A�RITE BELO�v THI�LINE O <br /> q0 403 <br /> � PERMIT CONDITI.7NS B�D 464 00 <br /> 1.All calls lor inspection shall be made 24 hrs.m ativance�phona 259•8810. � � � <br /> '�� 2.All work shall be pedormed in accordance w�th Ihis permit antl current G�ty of Everett Desi9' C s s � <br /> �� S�nndards and Specilications. <br /> 3.Call Locatien Underground Service 48 hrs.beloro you dig.TOLL FREE NUMBER 1•800•a 55. 4 � � <br /> o� v s2 00 <br /> (�s ,/ 79 <br /> .� T" /�'9ff`�� C/cron5��c��fS S/ml[ v�c� Ce.�n�cl�� f�� Y O <br /> •,. R 0. <br /> �)cC�Sc�t SidC Si?�✓er, G; S66 <br /> 1� 5 I>' exis-f.:y c�r.v�c-�j/ cc t is �,�:f c;s�'d i„ �n C �.,., <br /> „��� d;�,����,�y ��,t ,��, � , �y s�4,>da�-o�S, Dni�o-F V♦ <br /> to� oF c�,..G f�� insfRlC - ,('ecno✓e Cu�-G d O <br /> ( � � /fi�cck �� � � <br /> ��,,��,- �.�,�,�����.y �`� �y�� a <br /> !�! �p�����'�q .� <br /> 7 <br /> f� AG�`NOWLEDGEMENT OF CONDITIONS <br /> '� The unAe�sl9ned owner/applicanl here6y ag�ees tc hold and save haim� <br /> — less Ihe Cily of Everett Irom any and all cl,^ims lor Aamages, costs. <br /> / ezpen5e5. or CauSes OI aCiion ihal may afise beCause ol in5lalla�ion <br /> L� �� C and maintenance ol Ihc improvement or o�her ri9hPol�way usi� hereto <br /> � � ��"1 %Y applied tor antl furiher ap�ces (n ramovc same upon nolice from ihe <br /> Approved lor Consiruction - � ���� C�ly antl to replace public proP��ity damageA Ihereby. <br /> / � -� <br /> �GL��/� //' / � <br /> FINAL INSPECTION Date ���� - <br /> Appwved as ConsVuc�Ed Sic�nalure ol Apph ant Date <br /> WORK AUTHORIZE� !3V THIS PERIdIT MUST DE STARTED WITHIN <br /> evi•rctt PUBLICWORKSDEPARTMENT lgp DAYS OF DAl'E ?ERMIT IS ISSUED AND THIEREAFTER IS TO <br /> � 3200CedarStreet �E DILIG[NTL1' PU.a5JED TO COMPL[TION. THIS PERMIT MAV 8[ <br /> Everott,WA 98201 CANC[LLED BY THE CI;Y UPON ANY STOPPAGE OF WORK ON iHIS <br /> Phone:259-8810 pqp,7[CT OVGR d0 DAYS DURATION. <br /> i <br /> 1 <br />