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- - - ------ <br /> - - - - - - - - - <br /> - -- - - <br /> � ___ - ----- <br /> � <br /> _, ; � <br /> Date .— ` Z4 � c r--� 'Cv <br /> � vueuc vmrks Perm�i� ��' �L� I <br /> Application For eiag oer�.. �,���'� �, <br /> PUBLIC WORKS PERMIT P�°Te,qF�aF�a s = � <br /> TO POSTING �"zS�9s �essAooiFeePe�rl : .^_ _ i <br /> Print or Type Onry , — a��=�=a o�e S�- <br /> . ; <br /> � <br /> Azurc Ccnst 1320:; l3tic'�� �\t. �:ir';Inud [Jh �18q34 S�t-4i56 ' ' I <br /> Owner MailingAddress Cit� _ � ; , ZiP . Phone � <br /> . . . . � i-� �- . .� � � � <br /> Omn�r n,le Llovd . � . � � , . <br /> � Applicant . Mailing Address City 2ip Phone I <br /> I <br /> , Describe Proposed Work �"'-��% ��"t�"�� _ i <br /> I <br /> I <br /> /;�O3 3rd Av� « !_ 2' W I <br /> � <br /> ProjectAddress�ifknu•Nn) Y'l�i-'--i+r��-�1.���-,Si; _ -:-c�t—:-ShorC i`iat !rb-)2 � 'I <br /> iAttach four(4)copies of plans tor proposed�vork- Draw lo scale and note the tollowing as applicable: � � <br /> � • Property Lines • Centedine of street � I, <br /> I • Outline and dimensions of all existing antl • Indicale Norih <br /> , proposed structures on the lot • Show any proposed grading chanpes � <br /> • Existing and proposed uti�itias • Show measurr.menis � �i <br /> IDO NOT WRITE BELOW THIS LINE . <br /> PERMIT CONDITIONS O I <br /> 1.All calis for insp=ction shell be made 24 hrs.in advance•phone 259•8810. � ' <br /> 2.All work shell be peAormed in accordance with this permit and wrrent City oi E+erett Design and Constructlon <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER;•SW424•5555. � <br /> I R.,;�tic�, •Ltiu.•�cr •lu�li be di: cl:.u�..,� <br /> H) �f� (PIC :.tf8'R ��Rlln f�i 111.' FYB('rl❑ t. 1�,slt� n �u11�Ilr I <br /> u) 'Co arenide0:iai �nnl u� „i1�i��,u � .::���; ,i ��t;r.' ;��'i ���',�,i. i-` I .,t.i�� � �I <br /> Cllti :,'f811C18T:�n � <br /> c) �lnte •:plesh binc� :. I"� � <br /> ��If` Il1C�}IO(� Hd�CC� l�l�'lli h• ��r���•�.� f�i �'� .�i,., \4ntl l 1 ;^.I 1 i •N n'�I•l�.�-„l'.. � <br /> �. DYI�:PN�:n nil�.l fn.• �i 1� ��t, iioto ��ru� .�:�r i � c I�� .•d¢ �r �f�.�.. i ��..;v:qh � . <br /> O � <br /> a <br /> I ACKNOWLEGGEMFNT OF CONDITIONS <br /> �jy�_ , <br /> r°� '�i� i'� The undersigned owner/app'.Yant hereby agrees to hold and save harm- ' <br /> ,. less Ihe City ol Everett Irom any and aC. claims br tlamages, cosls, � <br /> � , eep��ses or causes ot acic� thnt may arise 6ecause of installation <br /> � � J��y"�� � � ' � � — arr ��aintenance ol Iha imp�ove:oen! or nthei righhof-way use here�o ' <br /> ' � �--+�—i �<<� � a�.�� � for and lurther agree. co re•nove same upon notice from ihe j <br /> Approv r ConsirucUon Date C � ��' to replace public properly d�imaged ihereby. <br /> ` � � i <br /> � �� 2 2 -OJJ ,�� l .�1 ( � r} ( <br /> FINAL INSPECTION Date y :�� � \ 1 -1 �' �" �I •� I <br /> � Approved as Consiructed Signature ol Applicant ... Date �. <br /> I PUBLICWORKSDEPARTMENT WORK AUTHOFiIZED 6Y -HIS PERMI? MUST 8E STARTED WITHIN ; <br /> 3200CedarStreet 18C DAYS OF DATE PERM17 IS ISSUED AND THEREAFTEq IS TO i <br /> I Everett,WA9820t BE DIUGEMLY PURSUED TO COMPLETION.THIS PEFiM1T MAV BE I <br /> Phone:259�8810 CANCELLED BY THE CI'Y UPON ANY STOPPAGE OF WORK ON THIS I <br /> PROJECT OVER 90�A�S DUh.,TION. �� <br />