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_ . _ --- _ _- <br /> _ ��-�,,., _ . <br /> 'X� <br /> Date �2 � � PunhcWorkePerm�i• _ <br /> Appliwtion For mnp o�m • <br /> PUBLIC WORKS PERMIT P°^;o:���`°° : — <br /> �essnon� �Peva�a S - " <br /> Baianceouc 5 �� <br /> Print or Type Only <br /> o�S��j -G J U� <br /> �og,�rer E - ,DE� L La i3E�'c-�= �N52o��F�u,.�2 ,Euc�� .��. 98�v I <br /> Owner Mailing Addrees City Zip Phone <br /> SR�-l�� � <br /> Applicant Mailinp Atldiess City Zip Phone <br /> Describe Proposed Work J �traw '���1��(/��-/ �M -r� yA� • <br /> _ W <br /> Project Addrv,s lil knownl — � <br /> Attach fom(4)copies ol plans for proposeA work- Draw to scale and note the tollowing as applicable: �'-; <br /> • Property Lines • Cent?rline ol slreet <br /> • Outline and dimensions of all ezisting and • Indlcate North - � <br /> proposed structures on the lot • Show any proposed gradin� changes <br /> • Ezisling and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BEIOW THIS L�NE O <br /> i <br /> PERMIT CONDITIONS <br /> 7.All calts for inspection shall be made 24 hrs.in adva�ce-phone 259•881 O. � <br /> 2.All work shal�be pedormed in accordance with this permit and curreM City of Fverett Desfgn and Construction <br /> Stentl�rds and Specitications. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> �,G, ,�,7<.(rCcva�/ l�/2�,« r /�° (���.., <.�.o/�ir:� �.7�/ Q <br /> /+ �� <br /> ,l�y�OZUL'-ry ./2:✓4.a-Cr>..ai J - � <br /> O <br /> � / � <br /> � G�ifrv✓ c-�iu.c.ee�,,�`y �.��.r' _ ,C�i�e..�l'� �,. .i .�..:r �Zt.� �:� <br /> z. ✓� �o�' �� �O-�,�' �� v�cF,� a.P�.r�<��- o <br /> • � � �nc�t� ?rL<<..,. ,u�( l'n-t�v /U'q.�•v�a� �f'r�� O <br /> �/ .� �.��.�,���.�, ��� � � a <br /> Z/w lt�.y �.�4u2ct'a ��'e/. // / f4 �� � <br /> (J ry(/ji�G /iJ 'orr"�":% <br /> % J <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Cily of Everetl Irom any and all claims lor damages. costs, , <br /> expenses, or causes of action that mny arise because ol installation <br /> and maintenance ol the improvement or other right�obway use herelo � <br /> applied br and lur�her agrees �o remove same upon notice Irom ihe <br /> Approved for Construclion Date City and to replace pubGc property damaged Ihereby. <br /> FINAL INSPECTION ���� Date <br /> Approved as Construc Si9nature ol Applicant <br /> JYORK AUTl10RIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br /> everett PUBUCWORKSDEPARTMENT 180 DAVF, OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTL`.' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt.WA9820� CANCELLED BY THE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br /> Pnone:259�8810 pROJECT OVER 40 DAVS f'JRATION. I <br />