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��� q., �_ �B S <br /> Date i �'�I� n,°K"b"�.«�"'. �-- <br /> Application For ���� <br /> PUBLIC WORKS PERMIT �°�W°�•F� <br /> To�.�r.. s <br /> �•u�wi r..voa s�_ <br /> eNane•ou� S �0 <br /> Print or Type Only <br /> flav;�l � ��• � T�5on 1�S�i,� _�'�.RuESE �'Q���' !L�}t(a�'� 35.s�i35`, <br /> Cwnar � Ma�N�9 Atldross :,ity Zip phone <br /> av��,� ��.�fyl �I�DmOsc� ;CS�i��,�"�'A-��_SE, L�f�.�,.`'N- ��' 1�� 3S5-�135� <br /> Applkant aflinq ACCress City Zip phone <br /> Gescdbe Propoead Work ` �� �� ��" S Q - <br /> ' r�•�— `,5�.(� W <br /> Proleet Adtlress lif known) � � h <br /> Attach tour(4)copies of plens far proposed work•Draw to acale and note the toltowing as applicable: � <br /> • Property Lines • Centerll�e ol atraef ♦� <br /> • Outlina and dimensions of all existing and • Indfeafe North V i <br /> propoaed structurea on Ihe lot • Show any proposed�)ratlinq chenqes <br /> • Existinq and proposed utilities • Show measuremen!s � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.!il calla tor Inepection shall be metle 24 hrx in advence•phane 259-8810. � <br /> 1.AI�.rrrle ahall be peAarmed in accordence wit�th(e permit and current Ciy of Everot:Deaiqn and Constructlon <br /> StanduJs and Specificatlona <br /> 3.Call Lacation Underyround Servica 4B hrs.befora you diq.TOLL FREE NUMBER 1-800-4245555. �� <br /> 7, Q�d�c+ar�c�' ,/� /?A�,c^t�t�� .�.o �a,.a'` 2w �a,ar�,�a�.�' ���+�`r � <br /> �10� tU�� .2�a �t/ C�.�.�/ °� �Gwu�` 4.�exy �I��� J <br /> ' - �ij 3�=d 2�e•S_F_ �O.Gt/. Lr..u�. O �}\ rA g4� ` � <br /> I(� ♦/� <br /> a�n� �vi <br /> V <br /> a <br /> ACKNOWIEDGEMENT OF CONOITIONS <br /> The undersiqned owneUapplicanf hereby aprees ro hold and save harm- <br /> — tasa t�e City ot Everett !ram any and all claims for damapsa eosta <br /> � expense4 or uusea of actlon t�at mey ariae becauae of installatlon <br /> �r � � and mainten�nce of the improvement or other tlg�bol•way uas �eroto <br /> applied far and turt�er agreea to remove same upon notice from the <br /> Approve¢A6r Constru on / Oatn Ciry and to replace public property damaqetl thereby. <br /> FINAL INSPECTION Date <br /> Aoprovetl as Constructed Siqnature of Applicant Oate <br /> everctt PUOLIC WORKS DEPARTMENT WOFK AUTHORI2ED BY TNIS PERMIT MUST 6E STARTED WITHIN <br /> �80 OAYS OF OATE PEHMIT IS ISSUEO ANQ :HEFEAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUEO TO COMPIETION.THIS PERMIT MAY BE <br /> Everetl WA 98201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona:259•8810 PqOJECT OVER 90 OAYS DURATION. <br />