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_ / <br /> �./) /�jy��4p Z <br /> Date_LY�/ PuhLCWo�ASPapimil,.,��_`� <br /> �� Applicatian For eiae oeo�.•—LV.�/ <br /> PU�IC WORKS PERMIT P°°��°w°�Faa— _ <br /> � <br /> .�,r��... a— <br /> p �e_e aoui Fee ra�n S <br /> � O O O O O O U <br /> Print or Type Only i � � �� � � `� � � � s��a��Po�e S�-0� <br /> a, o� rio3o o cior; vi <br /> G O �0.�+ ai C.J �O :� � .-� .�• <br /> vl u,-� ur w n .+ Ol �a <br /> p. N al al u� �Y <br /> ���.�-�'-�� �� `- I , t�vl 9g���� ��!-�� <br /> Owner �— � � ��¢�Q �ff�p w T�„ � Gry Zip Phone <br /> N OO WU UJ � OI- 03 U [� W <br /> \ OJ JW � O ¢ � �+� -" �+ _ <br /> (� 3e a1 ¢.k 61 n a 3 � til d] .+ cJ <br /> O <br /> Applicant Mailing Address Cit� Zip Phone <br /> Descrine Proposed Work ��� ���`--� ���911oue�([�!!�, �� � 4 <br /> / � <br /> _ W <br /> Project Address(it known) ��_ ��-14 - 1sT �z v� � <br /> Attach lour(4)copies ol PL•ms loi ^�opos�:J wod.• Draw to scale and note Ihe following as applicable: � <br /> • ProF�rry Lines • Centerline ol s�reet � <br /> • Outlme antl d nensiors ol all exis.in�3 and • Indicale Norih <br /> prcposed stn:;tures on the lot • Show any proposed�rading changes <br /> • Ezisting and�:roposed utilities • Show mcasurements � <br /> ����� <br /> DO NOT WRITE BELOW THIS LINE O <br /> PE� AIT GqN��ITIONE <br /> 1.P���-s��:�tor�nsnection�-all!_�made 24 hrs.in advance-phone 259•8810. � <br /> ?.a� :��,�. ;hali be pertor�n�.'�r �ccordance with ihis permit and wrrent City ot Everetl Oesign and Conslruaion <br /> . .. � ^.t JL'P-:�'lCb��JI 3. <br /> � ��� . � _ � .•�n _ :ervice 4B hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> S . ANY ChHNGN: IN THB DRIVEWAY CUT MUST BE APPROVED � <br /> 3Y THli PUBLIC WURKS INSPECTOR. � <br /> E 'lONNhCT �7JWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. <br /> B.KEFsP CITY STREETS CLEAN AT ALL TIMES. O <br /> 7.ANY DAMAGE TO TEs: CURB AND SIDfiWALK WILL BE R�PAIRED <br /> TO THE Sr.TISFC,� T.ON OF THE PUBLIC WORKS DEFT. � <br /> , � ACKNOWLEDGEM[NT OF CC �. -7NS <br /> �� The undersiyned owner/applicanl heretry agi ��� �nold and save harm� <br /> — — less the City of Evere�t Irom any and all � �, - Ur Camag�s, costs, <br /> �� ezpenses. or causes ol action thal may aris, .,ecause ol installation <br /> _�� {AJ� �� �«'-�-- �— I�'�U and maintenance ol ihe improvemen� or other ri�ht�o4way use hereto <br /> Aprruved for Constructiqn' , Date applied lor a � lurther agrea to remove same upon notice Irom Ihe <br /> City and to eplace publ-c erty damaged ihereby. <br /> / / <br /> ,'�!'�:�i"�- �_ca�Gi ` %� //G� ,/ �> <br /> FINAL INSrECTION Date <br /> Approved as Construr.ted gna�ure ol ApP��cant � Date <br /> everett PUBLICWORKSDEPAR7MENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED 1NITHIN <br /> 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel 6c OILIGENTLY PURSUED TO COMPLETION. i�HIS PERMIT h1AY BE <br /> Everett,WA9B201 CAKCELLED�Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�9810 PROJECT OVER�3J DAYS DURATION. <br />