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i <br />� <br /> DatB��.�.� � is�S ' <br /> ,� v�mKwor�ac�,•. <br /> ' Bk¢DeoL• — I <br /> Application For <br /> PUBLIC WC�RKS PERMIT "'':a.'"�'" s —�-- <br /> � <br /> � - L�u 11pp1 Fw P�IE ��� --� <br /> � B�I�nd Dv� / �I� � <br /> Print or Type Only <br /> . ' I a < SaD 6 ' <br /> Owne MeilinB Addreas City ZiP Phone <br /> �p�� �- <br /> Applkent Mailinp Addreas Ctty ZIP Phone <br /> Describe Proposed Work *rn � �!'�'���/ ��t <br /> W <br /> Project Address(il known) �� �� — 2 � � � I ' � <br /> Attach lour(4)copies ol plans for proposed work• Drew to scele and nate the following as appliceble: � <br /> • Property Linea • Centerline ot street � <br /> • putline and dimenalons ol .II ezistinp and • Indicate North <br /> proposed structures on tha lot • Show any proposed gradinp chengee <br /> • Ezlating end propoaed utllHlea • Show measurements � <br /> �. DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for inapectlon shell be made 24 hrs in advance•phone 259•8815. � <br /> 2. All work shell be peAormed in accordance with this permit and current City of Everett Design end Construction <br /> Standerds and Specificatlons <br /> 3. Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> J. �S � PGNitJT/�dC+ /Q/�r�S' �fLo �JG' Tc�P J� /I�c��r�'y O <br /> �c�c�r.��'.-v o n� ///fI/`�L r S .T `.��:. .Ji�'�'Gcr Cj�L��' /./3 <br /> c>/' STif��'Qj� . � <br /> � rf/�i� C/�r �c/✓CC^ LJ/LL i�cC «o�' �.oT'f,!av MHp�e. . � <br /> 6. y�>�9 7� �+C US'� �,c ,-'.q,r�;.�,� ,��90,0 ��.3 O <br /> /y'�>,p/f cr Ey�K/A'J7c�i;�i'__ — NG T 7-J d-�Gf !/Sr.�' � <br /> i7s' � Q'� � � i�,Pit'i.JG ��: -; <br /> � /f�c�iF.'.�_ .�i(: i�z i�r c .S/ �... /'2%',a]S I-i6'/'�J7i,�.�c �J' � <br /> � -TCl��r <br /> �`i�,.-�.^7 -���-- ��� i v�t�� ��%_�.�"•`) '"" `� � �ACKNOWLEDGEMENTOFCONDITIONu � <br /> The undersigned owner/epplicent hsraby preee to hold and eave.hertn• � <br /> leas the Ciry ot Everett jrom eny and �II delma tor demepeh, cost4 , <br /> _� � expenSe& Or caueas ui ACtiOn thal msy �rUa bec�uee of in6tellatlon ; <br /> ����� end meintenence of the imprrnement or other ripht-ot-wey une heroto <br /> epplled lor end turther e0rees to rsmova wme upon �otice from the <br /> p � y�N o� Dete City end to replace public property dam�ped tMnbY. '. <br /> � (���� � <br /> 'INAL INSPECTION Dete <br /> .pproved ea Constructed Sipnetu ol Applicant Dale <br /> WORK UTHORIZED BY THIS PERMIT MUST BE 8TARTED WITHIN <br /> ��n PUBLIC WORKS DEPARTMENT � 180 D S OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200 Ceder Slreet I BE DIL ENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE � <br /> Everetl,WA 98201 CANCE LED BY THE CITY UPON AkY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> I - <br /> � <br />