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�, /( ]�X�/ Puolic Worke Permlt r �� /�� <br /> Date �TT��� o ( `� 3,�'a/ <br /> Blap.Dao�.• <br /> Applicatlon For <br /> PUBLIG WORKS PERMIX `°°To:FeaFea S a, o . o � _ <br /> Lees AOV�-Fee Peld S_— <br /> Balanca Due S a� ' � � <br /> Print or Type Only <br /> �� �-(��. Oss y3�`I V��Qc�,,..,� �2, . � 5�zv3 <br /> e�nA.,�- <br /> � Mailing Address Cuy 2ip Phone <br /> �,�,��� ��o - /v��"(�e .S�' ��.�.� �3�� -avao <br /> Z <br /> Applicant 1 Mailing Address City LP Phon � <br /> n <br /> � a � �,�.r-s �.�n-, - �•� �J�L�r� "' <br /> Descrihe Proposed Work _�-��+=`� <br /> C/ <br /> -i T <br /> W •-� --1 <br /> (n T <br /> R� <br /> '� / ` ,-� O <br /> �7,3/y - ' l� .g.,-.r�� �.1� � m c <br /> Pro�ect Address(il known) � � c� <br /> -i c <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note lhe lollowing as applicable: � 0 3 <br /> • Centerline ol s�reet � m <br /> • Property Lines = -Z-i <br /> • Outline and dimensions of all ezisting and • Indicate North m <br /> proposed struc�ures on lhe lol • Show any proposed grading changes �" <br /> • Show measuremenis M �� � <br /> • Ezisting and proposed utilities `_ <br /> W � _ <br /> DO NOT WRITE BELOW THIS LINE O � N <br /> < <br /> PERMIT CONDITIONS o A <br /> L All calls lor inspection shall te made 2a hrs. in advance- phone 259•8815. � '� a <br /> 2, All work shall be perlormed in accordance with ihis permil and currenl Cily ol Everetl Design an d Construction --I m <br /> x <br /> Sla�dards and Specificatinns. r''� '" <br /> 3.Call Location Undergrou�id Service 48 hrs. Lelore you dig.TOLL FREE NUMBER 1•S00•424•5555. � �^ <br /> � ^ 1 1 I � I o r <br /> �1.�.1T�`aU�tii c� �.rrct ..+ ` r ci �.��c1-�.�� iw �-ke �l-�e�d c�m <br /> c v+ <br /> : � <br /> V1. Z"h y'1r f ��.�.��i C l�L�O ��c S -3^v� �n� c}� � /J r�or —i r <br /> 1 • m <br /> � � � a <br /> � ' o� ��« r n�s�j-�� e ri�� � p <br /> (e w�-v .� .�.. ` ���I -i <br /> ` ` f / x <br /> L�...rb �,,, �.��_e JG-� e �^ t,J- `l-i.�c �^�Pc�:F'. nP�-�+ z <br /> I o <br /> � <br /> ��.J 2 wa� .. <br /> � <br /> a N <br /> Z <br /> 0 <br /> � <br /> �=, <br /> m <br /> � AGKNOWI!-DGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereUy agrees to hold and save harm� <br /> less the City ol Evere�t from any and all ctaims lor damages, costs, <br /> � ezpenses, or causes of action that may arise bewuse o1 installation <br /> � / and maiNenance ol ihe improvement or other right-of�way use herelo <br /> � r �l'��'�� �y_b� applied lor and lurther agrees to remove same upon notice hom the <br /> A`roved lor Construction Date City;�nd to replace public proper�y damaged Ihereby. <br /> . / <br /> �----> <br /> �� =-�� ��•-:-�r (� ' I � �,�v L,-��I- �`�r <br /> FI AL INSPECTION Dale �1 ����'-\ ) -�� �• � �^ <br /> Approved as Constructed Sic�nature of Applicant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THC-REAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PUHSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 C�NCELLED BY TH[ CITY UPON �NY STOPPAGE Of- JJORK UN THIS <br /> Phone 259�d015 PROJECT OVER 50 DAYS DURATION. <br /> ! <br />