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_ �"f <br /> 1. . <br /> r <br /> ���� J �7/[ Z ruo��c wo�.s vo,mii <br /> � Date�:"�-9C� �'� T�J POSTING�� �"L� <br /> ��� nina oeoi •� � .�— <br /> �r Apnlication For <br /> " PUBL�C WORKS PERMIT ^°^°°w°,�•'°a s <br /> ��� Tota�ire <br /> � Less o001 FpC Paitl 5_ <br /> W O <br /> O �+ �-' r' n n ' =' r-' n oairncc e�c S ZA' <br /> .� r �� nc� :,-, o o `o' _� oc � <br /> p Print or Type Only � <br /> HC �n inino .ro o ri :� n �n , <br /> .r m tn m .a r.� v� r? .+ �� c <br /> O H .-y utn+ w e: w e> ��> w � � <br /> p�g -1 � �nr�t'� � � , _�>� "� ;�Ul f�'rl/ � 4��7[� 3��/J�, <br /> A Owner � ��� h ifi� r6 s��� "' !, City Zip Phone <br /> �u o c� c� � .�+-,� .� n i;� , ti <br /> �H� Oora �• �� � r.� �- C� x nr- �.� � <br /> s H \ O _1 J I:J ' U 2 f� W , <br /> r� ni :s: �i � r. u� c� .c _[ -r. m :i �. i� <br /> M � <br /> �� �„� pppllcant Maiiing Addr�ss CiW Zip Phone i <br /> ����+ � / n / — I <br /> �J[b Describe Preposed Work ��<-��� `-'�-��—�� — � <br /> C1 Go I <br /> ---- W I <br /> Projecl Atldress lil known� �o Z �.�j ' �. S't ._71Z. `�� � � <br /> I <br /> Allach lour(41 copies ol plans br proposed wo�h-Draw to:cale antl note the followin�as apoliwble: � I <br /> • Property Lines • CeNerline ot street ♦^ <br /> � • Outline and dimensions ot all existln9 and • Indicate Norih V� �� <br /> - proposed sirudures on Ihe Ioi • ShoH any proposed gradin9 changes <br /> j--� ��l • Existing entl proposed utilities • Shcw measuremenrs � <br /> IC�, DO NOT WRITE BELOW THIS LINE O <br /> 1 ' PERMITCONDITIONS II <br /> �� 1.All cells lor inspection shall be made 24 hrs.in advance-phone 259•8810. � �� <br /> ' 2.All work shall be peAormed in atcordance with this permit and current City ol Eeerett Desic�n antl Cons�mction i <br /> � ��a Standnrtls and Specilications. <br /> , 3.Cnll Location Unde:ground Service 48 hrs.bebre you dig.TOLL f°REE NUMBER 1-800•424•5555. � <br /> �� O� !� 4.ANY CHANGE IN THE DRIVhWAY CUT MUST LE APPROVED <br /> BY THE PUBLIC WORKS INSPGCTOR. <br /> 5.CONNFCT I�WNSPOUTS TO PUBLIC DRAINAGE SYSTEM. � <br /> �'s�. ' 6.KEEP CITY STR�ETS CLEAN AT ALL TIMES. <br /> �, ���� 7.ANY PAMAGE TO THE CUFB AND �IDEWALK W7LL BE REPAIRGD N <br /> TU THfi SATIS['FlC'f10N OF THE PUBLIC WORKS DEPT. O <br /> ; � �_� a <br /> � <br /> � <br /> I 'w . <br /> �I � ACKNOWLEDGGhtENT OF CONDITIC' <br /> � , Th�undersi9ned owneVappliwnt hereby a�rees to h , .save Imrm� <br /> - — — less ihe Gty ol Everett hom any antl all claims 1. iages, cosis <br /> expenses, nr causes ol action thal may ariae bec � • ol installatlon <br /> �_ � �p�t �� � I�� � and maintenanCC of Ihc improvemeN or othcr ri�jhP���way use herMo <br /> CAM�+'� applied lor and lurlher a�rces to remove same upon notice Irom Ihc <br /> ApProved lor Con,5l�uclion ���^ City antl to replace public property damanetl Ihereby. <br /> ^ �l�Gl�- �o�'�7 �� i. /, � / '_ `•�.. <br /> FINAL INSPECTION Date — =� a � -/� �G' <br /> Approved as Consiructed -51 ature of ApplicaN Uatu <br /> PUDLICWORKSDEPARTMENT ���ORK AUTHORIZED 6Y THIS PERMIT A1UST BE STAriTED \NI7HIN , <br /> eve�ett � 180 DAYS OF DATE P[RM111T IS ISSUED AND THERE�FTER IS TO <br /> � 3200 Cedar SUee1 9E �ILIGENTLY PUHSUGD TO COMPL[TION. THIS PERAtIT MAV BE <br /> Everet4 WA 982U1 CANCEII [D 6Y TH[CITV UPUN ANY STOPPAGE OF WORK UN THIS <br /> Phone:259-8910 PROJE�i 7V[R JO DAVS DURATION. <br /> I � <br />