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a <br /> i+ <br /> /i <br /> J. .-� _ C � „ ..�...�.,,.,��v...m,.. <br /> Ca;c'-- � .. q _ /� /� - . <br /> 6in9 �ePl . / / ',4�'��(�Y.--" <br /> Applicaiion For <br /> PUBLIC WORKS PERMIT �°°°°�°°,k,F°° -- - <br /> ,��.,��e� s <br /> ie.sapm �ceram 5 <br /> n.,�.,r���o�� 5 <br /> �r,d Print or Type Only �- <br /> [�1 L�1 <br /> � y ///f / _ / �/ /� / <br /> q y y /�f-[��LLo L-//ZG��"YLP.�L"LC. Gf.3�7� ��,5{C-c-G^r' .S�E �� _'J_ �l� SC7 <br /> a <br /> H � O er Mailmg Address City Lp Phone <br /> "�z �! t�/L✓l <br /> �H� Applicanl Mailin9 Adtlress City Zip Phone <br /> fA H <br /> xx Describe Proposed Work �� ��� <br /> [�1 O� <br /> H <br /> � H ' <br /> ��g <br /> �y C���.j' ' 7 W <br /> �" H y Prolec�AddreSs(il known) �� �7� /��� ����� — — — � <br /> g y Altach four 14)copies ot plans lor proposed work- Draw Io scale antl note ihe lollowing as appOcable: � <br /> H <br /> n d y • Property Lines • Cenlcrline ol street /A <br /> ��r • Outline and dimensions ol all existin9 and • Indicale North V� <br /> L�7 proposed structures on Ihe lot • Show eny proposed yradin9 chan9rs <br /> y � � • Existin9 and proposetl utilitms • Sho���measuwments Y <br /> f� <br /> � --� 00 NOT WFITE BELOW THIS LIN[ <br /> PERMIT CONDITIONS O <br /> 1.All calls br inSpeCiiOn 5hall 6e made 24 hr5.in advanCe�phone 259•8810. � <br /> � 2.All work shall be pedormed in accordance with�his permit and current City of Everett Design and Consiruction <br /> � _ StandardsandSpecifiwtions. <br /> ��1 3.Cali Location Underc�round Service Qd hrs.before;ou tlip.l'OLL FREE NUMBER 1•800•424•5555. <br /> � Z <br /> /J ' /� J � O <br /> � �� �'�. � � ��:';t�,�..�' . t'�rr ,CCC�t ct t�' ��/ ' � � <br /> �,�k�� LL�G v � ����Y�C�•�i/ <br /> I '�I_� f/ ! �9 // n �//��r <br /> /�L�ZVC�/ .S� � yt -GZ ..(�CD�f�1 !L2 .C/j /JVX.t`- � <br /> Ty�2, Cri�i C lu- J� � � <br /> '� CL���'e-.� ?�+�a.� ��e �lc�cl/ r-u�i� �}resL�,� <br /> �' <br /> �� S�E SL�[ulLev• C(�rSO) Sie«e.x, .�1+ecL� x. �!�'!i. ; <br /> �l�ZCG.L1 !J� .CG 6y/7a.�u�' -.�i7 �»cLf �4.�-�:L�t/�<�-�.� "y <br /> _ �.L� � ��,�v���LY u, Q, ACKNOWLEDG�MENT OF CONDITIONS <br /> ' � .,q ` The untlersi9netl owneUapplicant hcrcUy agrees to hotd and save harm- <br /> 1�1� less ihe City ol Everett Irom any and all claims br tlamages, costs. <br /> expenses, or wuses ol aclion iha� may arise because o� installalion <br /> �nd maintenance of Ihe improvement or other iighPol�way use hereto <br /> apphed lor and further aqrees to remove same upon notice Irom �he <br /> Approved lor ConsVuclion Date Cily and te ieplace f.�olic property tlama9etl thereby. <br /> FINAL INSP[CTION Dale ��"A^'r""�-=L�I S ( <br /> Approved as Conslructetl Siynature ol ' �plicanl ����� <br /> cvemll PUBLICWORKSDEPARTMENT WORK AUTH RIZED BV THIS PERMIT h1UST BE SIARTED WI HIPI <br /> � 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AN� THERE�FTER IS TO <br /> Evercu,N'A98201 BE DILIG[NTLY PUFSUED TO COMPLETION. THIS PER611T MAY BE <br /> Phnne 25^_���70 CANC[LL[��Y TNE CITY UPON ANY S70PPAG[OF WORK ON THIS <br /> PROJ[GT OVLR 90 OAVS DURATION. <br />