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� �� <br /> �j/j %6 ���,���,�w�,�,�,.,m�. _- - -- <br /> Date —-- <br /> ri.�i;� ocoi • _ --- <br /> i <br /> � � Applicalion For <br /> PUBLlC WORKS PERMITi ruoircwa�waFre <br /> Tpin1 Ff <br /> Lalf ApYI f 'e�J S� <br /> �dlpflC 110 � <br /> Print or Type Only <br /> � " �/� � 7 �x7 Gy ,-�' ✓u�, ,,�,� �(1�� 3 5 � - 5 �S' � y_ <br /> '/ - Idallin9 Adtlress -' City Zip Phonc <br /> Owner <br /> - _s.Q�� — �'�� 3 — <br /> Cit Zip Phune <br /> Applicnnt Mailing Address 1' <br /> /� 7i— <br /> �t/�/i�1 � l / i i` �i� CLLcti�,G'� ./"�2L�v ' 7 Ec�J <br /> Describe ProposeA Work _S_^'='"'�"� i^ \ <br /> �7� �� �c l T- Gv � �/i /✓c.j/-�� � . <br /> �'� W <br /> - 7��� u,o��,� �i�.�r= � � <br /> Proiect Addres taowN <br /> � <br /> Attach tour(41 copies ol plans for proposed work- Draw lo sca�e and note the lollowing as applicable: � <br /> • Property lines • Centerline ol street <br /> r Indicate North <br /> • Outline and dimensions ol ell ezisting and � �ho�y�ny proposed c�mding chanyes <br /> proposed structures on ihe lol • Show measurements � <br /> • Existinp an0 proposed utililies <br /> � DO NOT WFiITE BELOW THIS LINE O . <br /> PERMIT CONDITICNS � <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance� Phone 259•881 5. <br /> p, All work shall be perlormed in accordarce wlth this permit and r,urreN City ol Everett Design and Construction <br /> Standards and Speciticetions. � <br /> 3. Call Location Underground Service 48 hrs.hefore you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> � l `!S' c�/�«'F�-�-� � <br /> C�v�S�/ON C�i��� c.'�� — C; /' <br /> -J�/ //��.5'/'c--c/�r i�' � , <br /> � <br /> Fyw <br /> _/ <br /> O <br /> a <br /> ., <br /> �CKNOWLE�GEMENT OF COYDITIONS <br /> The unders�gned ownedaPplicant hereUy agr�?es to hoid and save harm� <br /> - less the Ciry of Everetl Irom any and all claims lor dama9es, costs, <br /> �' �• ezpenses, or causes of aclion Ihat may arise because of installation <br /> and maintenance ol the impro�ement or olher right�ol-way use hereto <br /> / .:, J' / � applied tor and lurther ac�rees fo remove same upon notice irom Ihe <br /> qppr v �Co ructi a . Dale Cily and to replace public property damaged Ihereby. <br /> r ; , , , � ��_� <br /> % ' � n � <br /> ' - �' �G��f�x���-��ti�� <� 5! �: <br /> .. i Dale Date <br /> F NAL SP CTION � SiflnaWre ol Applicant <br /> Approved as Constiucled yypRK �UTHOFIZED 9Y THIS PERMIT MUST BE STARTED WI7HIN <br /> �,������ PUDLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS i5SUE0 AND THEREAFiER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUE� TO COMPIETION. 7HI5 PERMIT M�Y BE <br /> Evcrclt.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> Phonc: z59�B815 PROJECT OVER 90 DAYS DURATION. <br />