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' � ' 1 vw����wc-isr„m�1• f� --. . . <br /> Dale I ema oeo� •���'�/�--- <br /> ApPlication For _ <br /> PUBLIC V1�'ORKS PERMIT `°°���a�«�"� S — <br /> �exz nnoi ree ra�e 5 <br /> o�m���o�� 5 <br /> Print or Type Only <br /> � � � <br /> >y MR2.0 1Jo2:R-t�UP 37D(o �P�A�D Av�' E.rc�,c1T `?£jozt� 348�651 <br /> 4'�~ Ownm btadin9 Address <br /> c�v z n �no e <br /> AHC/� <br /> 1 <br /> H � � ��NN��L. Pnon� <br /> K y� Applicani Mailing Address Cily ZiP <br /> �~� E — <br /> v, � <br /> y Des�nhe Proposed Work <br /> � O� ' _ <br /> H C7 <br /> �� g W <br /> �V n � <br /> �y� 70Co UPLF�ND PcJE <br /> Froieel Address Iil known) � <br /> + z � <br /> H rJ A�r,�ch lour I4)�opies o�Plans for p�oposed wo�k-Oraw lo scale and note the lollowing as apP�ieable: � <br /> g � • Properly Lines • CenteAme ol sireet <br /> H • Indicate Norlh <br /> O ty V� • OuUine antl dimensions ol all e*islin9 and � Show any propo5ed 9�ad�n9 changes <br /> �� � proposetl struclures on ihc lot � Show measurements /� <br /> • Eaisiing and pwposed uiilibes �� <br /> x H f/� <br /> H O V� 00 NOT\VRITE BELOW THIS LWE ♦\ <br /> � �% <br /> PERMIT CONDITIONS ^ <br /> ����' 1.All calls for inspection st:ali be made 24 hrs.in advance-phone 259•8810. <br /> Z All worh shall be pertormed in acrordance with this permit and cuuenl City ol Everelt Desipn antl Consiruclion � <br /> Standards and Speciticalions. � <br /> � '�_ <br /> 3.Call Location Undergiound Service 46 hrs.bebre you tlig.TOLL FREE NUNBER i�ECi�il•424•5555. <br /> � O <br /> � /� V}� <br /> I_' ��/�C.�CCCI�Ii'Y C�V'_✓L�� �1 ir <br /> I /7 , ! /� � <br /> j�,%•,�'< <uez:''Q /?.t.r„cf ��'�'� '��`''�,`u�`1,. <br /> �J � / � <br /> � i/' f-a'ic'Cn'�-`— <br /> w_'_ �.�.1 '/��%� � <br /> ' I 1 ' � ACKNOI'1LEL'G[MENT OF CONDITIONS <br /> The undersignetl owner/applicanl hereuy agrees lo holtl and savc harnr <br /> �'�1 ' less ihe City of Everett Irem any antl all clalms lor dama9es coslc. <br /> _ ezpenses. or causes of aclion Ihat may arise because ol installavon <br /> and mainlenancc of ihe improvemenl or olher n9hbul�way us� :�en��o <br /> - applied for and further agrees b remove same un��� ��������' �rom the <br /> Appioved br Conslruciion Da�e Ciry and to replace public prop^rty damagetl Ihereb)'. <br /> ,'INAL INSPECTION Datc p;��i. <br /> dpu�oved as Consiructed <br /> Sinnature of APPlmant <br /> ^ WORK AUTHORIZED BY THIS PERMIT MUST 8E STARi[D WITIIIJ <br /> f�vcrrttI �UBLICWOF7KS�EPARTMF'IT Ig0 DAYS OF DATE PEf�M1T IS ISSUED AND THEREAFT[R IS TO <br /> ; w I 3200Cedar5lreel OE DILIGENTLY PUP.SUEO T�COM11PLEfION. THIS P[Rf.11T A1AV BE <br /> UEverett WA98201 CANC[LLED��THE CITV UPON ANY STOPP4GC OF NORK ON tH15 <br /> Pl+one 259-8810 PFOJECT OVER 90 DAYS DUF7�TION <br />