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, <br /> �— �2.��_� �, ,�.�,_ _ . <br /> 2�21 92 !1 p fT r,�m.�w���sv�����u �1 �'�_ : <br /> Date_L �ll f-QJ I�1117_._ 3��° 9 n���o��� , 92/35703 , <br /> Applicai�on Por <br /> PUBLIC WORKS PERMIT `°°ro`"F��"° � <br /> � <br /> LceeApi�l Fae PaiO S j <br /> Onlanar Uuo $��Q � I <br /> ��'i1 Print or Type Only <br /> [-f a y . , , . . � ' . <br /> ,a�x � <br /> 9 y y � � 337-7153 ' <br /> Hx93 Owner Mailin9Adtlress Cd•, �•, ' ' ZiP Phone �� <br /> H x H � . - � i�.� �. <br /> `� y� . ,. ' , , . . . � . ' - � <br /> oxo <br /> owner "� : r', <br /> '�1 N H Applicant Mailing Address City ZiP Phone , <br /> y C <br /> � z <br /> y d Descri6e Proposed LNork i <br /> H CiJ O i <br /> 4]� C❑� — � � <br /> 9 H trJ 7��� — i <br /> r H H Proiecl Address(il knowq YX fi 61eA--D � . ' <br /> ti <br /> '� Attach four(4)copies of plans for proposed work- Draw to scnle and note the following as applicable: � <br /> C] Cy //� I, , <br /> p C� • Property Lines • Centerline of sveet , <br /> � C`� • Jutline and dimens�ons ol all existing and • Indicate North e�� � <br /> � • Show an ro 9 9 <br /> Z y C/� proposed structures on the lot y p Posed 9ra in c an es � . <br /> H O V� • Eaisting and proposed utillties • Show measuremenis � � <br /> DO NOT WRITF BEIOW THIS LWE O � I <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspeclion shall be made 24 hrs.in ad��ance-Fhone 259•8810. � , <br /> 2.All work shall be pertormed in accordance with Ihis permit and current City of Evere�t Design and Ct�struction , <br /> Slandards and Specilications. � <br /> 3.Call Location Underground Service 4E hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. � . <br /> � w �{ . 'EXTE1�11� GDNCQ.ET� C�Jl.YE1c.T /�T SOv�-1 PR-OP EK-l"�' l-1t�?C. O � <br /> ly � iTcH �.�NE Ac2osS NE��/ o�.�vE�v��f .�2E7=- - t'IATc_{{ <br /> �+* ... EX�STttJCa S �ZE � 'TYPE . � <br /> �� <br /> V� � <br /> I�" .- r � <br /> � V � <br /> �..� <br /> I d�� � <br /> ' > ,�` �CKNO\VLEDGEMENT OF CONDI710N5 <br /> "'� ' �y(" The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> ✓' less ihe City ol Everett lrom any and all claims for damages, costs. <br /> expenses, or causes o� aclion lhat may arise because ot installa�ion <br /> '� f1 t�1 `,1 and mainlenance ol the improvemenl or other nghl�ol-way use herelo <br /> +� �Ql�.`JL � \G� 1'1�Z � '9z applied for and further a9rees to removc same upon notice Irom Iha <br /> Approved lor Co 5,6ction � Date City and to replace public properry damaged ihereby. <br /> , ./�,F�-��� �s��� , , y_z�—� � <br /> FINAL INSPECTION H y <br /> Approved as Construeted Da'� ��nature uf Ap?lic� a�n'I—/ Dale <br /> WORK AUTHOH!ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> F'UBLICWORKSDEPARTMENT 180 OAYS OF DATE PERMIT IS I.�'iSUED AND THEREAFTER IS TO <br /> �V� 3200CedarStreet BE �ILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �_ [verett,WA98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORI<ON 7HIS <br /> Phonc:259�BB10 PROJECT OVER 90 DAYS DURATION. <br />