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/`�,�TV Pu�I�cWorkePer . �� '��'z <br /> 178tf3��� �� � � �. _ <br /> B�eo oao�.• <br /> ApVlicution for <br /> PU[3LIC W�DRKS P�RMIT PuoTo��aFea s <br /> Lenn Apo��Fec Pe�E S P /' ^� <br /> </. G� <br /> Balanc�Dve S. <br /> Print or Type Only 7�� '�`f <br /> � , � � I `-'��� J7cve �t /l� � S �+ 3 �J - ��6 <br /> �> q c1<: o F? +� � <br /> wner <br /> Mailing Address City Zip Ph�ne <br /> �� ht-e� — ZiP Phone --- <br /> Applicant Meiling Address City <br /> {'4, I J �'�2 = <br /> a <br /> Describe"roposed Wo�k -- "�'� <br /> �. <br /> n <br /> m <br /> W ;T <br /> � ~•--1 <br /> /D70_S - 3 %'d/,'r.-t�.�E. _ � _ <br /> Project Address(if known) _ �`� <br /> �� o <br /> Attach tour(4)copies ol plans!or pmposed wo�k-Draw to scale and nole the tollowing a.s applicabte: � o <br /> I mo <br /> � prppr,rry Lmes T Cenlerline ol street � � <br /> • Indicate Norih �� <br /> ! Outline ond dimension5 0l all existing and � m <br /> proposed strucWres on Ihe lot • Show any proposed grading changes <br /> • Ezisting acd proposed utilities • Show mcasurements M = -¢ <br /> W "' <br /> DU NOT WRITC BELOW THIS LINE O 'c � <br /> r � <br /> PEHM�T CONDITIONS � .� N <br /> 1. All calls lor mspeclion shall be made 24 hrs. in advance� phone 259•881 5. K <br /> 2. All work shall be perforried in accordance with�his Germit and current Ciry ol E��erelt Design and Coostruction T <br /> StandarAs and Spec�7ications. �D <br /> 3. Call Location Undurground Service 48 hrs.6elore you dig.TOLL F(IEE NUMBER 1•800•424•5555. � ,� �� <br /> x <br /> m �� <br /> O o., <br /> 0 <br /> nf <br /> 3 � <br /> � m <br /> z c� <br /> -�r <br /> � m <br /> a <br /> � <br /> � y <br /> a� <br /> z <br /> � s <br /> v <br /> C <br /> -� <br /> ACKNOWLEDGEMENT OF CONDITIONS r' <br /> r� <br /> The undersigned owne�/applicaM hereby agrees to hold and save harm� <br /> less the Gity ol Everell irom any and all claims lor damages, costc, <br /> expenses, or causes of action that may arise because ol installation <br /> � !j, ry,�J c,/ ,1s� aPp mamtenanco ol the improvement o� other ri�ht�obway use herelo <br /> � � �T a lied lor and further agrees to remove same upon notice irom the <br /> Appro� d lar Construction �a�� CNy and ro replace puhlic property damaged Yhereby. <br /> .�.�.� ' (��c� -�5 -, _ I� -��-�y <br /> FINAL INSPECTIOIJ Oate Date <br /> qpproved as ConsUuctetl Signa re of AF P�icant <br /> ^ WORK AUTHOHIZED BY THIS PERMIT MUST BE STARTED WIThIN <br /> IeverettI PUBLIC WORKS DEPARTMENT �gp DAYS OF DATE PERMIT IS ISSUED AND TN[R[�FTER IS "O <br /> � w I 320G Cedar Sireel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> ��( Everett.WA 98201 CANCELLED PY THE CITY U?ON ANY STOPPAGE OF\NORK ON 7t'IS <br /> �� Phone: 254-8815 pROJECT OVER�0 DAV� DURATION. <br />