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�•'� �Cc� <br /> Date ,.,. ; .� �•.,� . .1- �-- — <br /> i�.,, u.w . r/U�a�-�-5 S <br /> r- ApPlicatlon For <br /> PUBLIC WORKS PERMIT "���°;�;°�e.`�° a _ <br /> ;� �,,,.,o� �,.P.,,,� s <br /> :� <br /> Hx O H �'_ „ o o r, o c� � , o.i,.,ce o�e s 2�— <br /> �f[rsl y Print Or Type Onl�� ''. `: �' -; "� �? `� _ <br /> - p t� <br /> b� C�1 Vl lf� {�l ..+ Pd IA <br /> O�'X. � t7 w: M :♦ M �t <br /> aH fJ n N w ^ <br /> yc� y ,{� <br /> x C rr i 1- �7�/-!�',t e �NlV�� !r�'Oa �No� �'JvP (,G �.��/Pi/ l-� 9�ZD� <br /> H 9 3 � ai�oc AAtl�ess City Zip Phonc i <br /> H ZH Own � c�� . � <br /> � y� Y � � J JJ � � _ <br /> /y : � .� 357 — 33 �� <br /> O r�O C V,�A^ � �C [u 4 r fi 6] Ll LJ <br /> J ..� <br /> � q1H AppliWnl Mailin�Adtlress G�y Zip Phunn <br /> �y z� <br /> H C Oescnbe Proposed Work � �e� ��'����C� <br /> OH i <br /> "`�g i <br /> > y� � I <br /> r H H ��Z 21.1(J /�,\/� .� � � <br /> ty VJ Proiec�Address 1��knownl � <br /> H <br /> n dC,y Attar.h lour(4)COp�es ol plans lor propGSetl work� Draw�o sCale anA no�e Ihe lollowmq as appl¢able: � <br /> � [q� • Properry Lines • Cenlcrhn�ol stre?t '^ <br /> x y y • Outline antl dime�sions ol all existing and • Intlicate Norlh V� <br /> y 0� propo5etl SIruCW re5 on Ihe lot • Show any propo5etl 9�ad��ng chan9es <br /> • EaiSiing and proPosed ulildies • Show mea,urements /�/� <br /> W <br /> DO NOT WRITE BELOW 1HI5 LINE � � <br /> PERMIT CONUITIONS <br /> 1.All calls lor inspectio�shall be matle 24 hrs in advance�phone 259•6810. � � <br /> 2.All work shall be pedormetl in accordance wilh this permit a�d cwrent City ol Everett Desiyn and Construction I <br /> � Standards and Specilications. <br /> '� 3.Call Location Undergmund Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> ' ' q. A(�P���c...-t Sh..l� �,��rz.a� �.Ja-4er �Sv.�or 1 �.cd �.ih.�.�c <br /> -{�{„_„ Yv h �v�r�w �mvo.eye., c:iAt,�t-�Yw- -f�i r..cek v- P.L' . w"e,� O �I <br /> ; i -d. n <br /> �" '� '����c�-C M1en� w.w'{,w a.e-✓J�C�. SKv'f' v�� a.. {'S�d-Cv� S�� (V14a , � <br /> U � <br /> N ' <br /> _ � O <br /> � �-, p, <br /> ;� "'' ACHNOI'JLEOG[�dEN7 OI"CONDITIONS <br /> �;;� The undersigned owner/applicant herehy agrees to holtl and save harm� <br /> iess the City o� Everett Irom any antl ali claims for damages, costs. <br /> ,� � ' �� t�✓ eapenses. or causes o� action that may nnse because o� installaUon <br /> �� 1`�j „ � ���J P � �� � and mainlenance ol Ihe improvement or otber nght-ol�way us<� neu�to <br /> � �Mti'�• �p applied �or and lurihe� aQreeS Io remove same upon nol�cr Irom !he <br /> �+n oved tor Gonslrucjio ;� Date ���y�nd to replace pu6hc prooerry damaged thereby. <br /> .. •� i , /� <br /> ; � �, �r`���-'� -2l�� - 9-7� ///' /)�/ <br /> FINAL INSPEC710N Date �-�o � ' � ' ' p��— <br /> �nProved as ConslructeA Si�rLt(Wre of Apphcant <br /> WORK AUTHOF12ED BV THIS PERMIT h1U5T BE SiARTED NIiHRI <br /> i.�i•��g� PUBLICVJOFKSDEPARTMENT I80 DAYS OF DATE PERMIT IS ISSUE� �ND 7HEREAFTER IS 70 <br /> � 3200CeaarStreet BE DILIGENTLY PURSUED TO GOMPLETION. THIS PERL117 tdAV BE <br /> Everetl.WA98201 CANCELLED BY THF CITV UPON ANV 510PPAGE OF WOF�h OPJ iHi� <br /> Phone-259�8610 PqOJeGT OVER :;G �AVS DURATIOPI <br />