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/ <br /> Dale�J�`—l��— r=����<<,��,..��.,m�� � `��Z�����- <br /> ❑i.p Deot• <br /> ppplication For <br /> PUBLIC WORKS PERMIT �°"°""°`�„`° <br /> iolal�ee S <br /> 1-3 [] � Len AOC�Fee Putl S' <br /> 4� 1"1 �/�.�- <br /> O L e.vancc oun S �-� <br /> �p � x Print or Type Only <br /> ❑ ri <br /> � yx� � 2 f/1IC-� <br /> � - �— <br /> y �x H � �'k�k�t-� C i��'l�Y� �Z)?c�' U�C"� �l_ ��1�Y 1 I _ `�`�l�'� � i <br /> K y � Owner a Maihng Atldress . Cny Zip Phnne <br /> �H � �t-t�rl� .�S �lf'�aJ� <br /> UJ H ----__ <br /> x Applicant Mailmg Address City LP Phone <br /> � O� <br /> �3 n p `/ � I 1 � <br /> HC+fO DescribaProPosedWork l�-�'IX''��f� �h�sl�N�l ��t`��� ��� K�/1 � _ _ __.___ <br /> G]� C] <br /> H � <br /> � Hy - � <br /> � 7� z� �/1 G'7�O��Z- � <br /> ~ Projrcl Adtlress(il known) <br /> C]C❑7 V� <br /> � I•7['� 4ttar,h lour(4�copies of plans br proposed work� Draw lo scale antl note ihe lollowing as applica6le: �� <br /> y y • Propeny Lines • Centedine ol sireet � <br /> H O N • Oulline antl dimensions ol all exis�inq entl • Indicatc Nort� <br /> � ProPosed siructures on ihe lot • Show anY ProPosed grading changes <br /> • E+is�in9 and proposed utilities • Show measuremenls M <br /> 00 NOT WR:TE BELOW THIS IINE O <br /> � PERMIT CON�ITIONS <br /> � �_ 1.All calls lur inspection shall be made 24 hrs.in ativance-phone 259•8810. ^ <br /> + 2.All work shall be pedormed in accordance with Ihis permit and current Gty ol Everelt Des�3n and Construction � <br /> � Standards and Specilications. <br /> 3.Call Location Untlerground Service 4B hrs.6ebre you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> � �.� L�. ���(� � C- x I �/ /�l,'Cj .4L/ <7/L:' /71C-Z,' ( . � <br /> � <br /> �sl I �� (� <br /> � �` .� O <br /> � j ��� ���� � �/�� ���` a <br /> _� � � �� ,,, >; � �� <br /> � � <br /> i- <br /> I� ACKNOWLEDGEMENT OF CONOITIONS <br /> The undersigned owner/anPlicant he�eUy agrees to hold and sacc hnn,r <br /> less ihe City of Everett fwm any end all claims lo� Amm�qe,. cosi� <br /> �� eapenses, or c0use5 0� adion ihal may arise becausc ol msiallabon <br /> and maintenance of Ihe improvement or other ri9hLof�e:ay use her„�c` <br /> applled lor and further agrees to remove same unon nobr,c !mm u��� <br /> Apurove lor Con,S! uctio 'a1e City and�o replace puUlic pmperty damaged ihereby. <br /> / <br /> FINAL INSPECT�ION Date �,��i, <br /> Apnroved as Constructed Signalwe ol APP�icant <br /> WORK AUTHORIZED BY 7HIS PERMI7 MUST OE STARTED WI7HIN <br /> � PUBLICWORKSDFPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THFREAFTER IS 10 <br /> �200CedarStreet BE DILIGENTLY PURSUED TO C064PL6TION. THI; PERMIT .'J�AV �[ <br /> Everetl,WA9820t GANCELLED�V THE CITV UPON ANY STOPPAGt-OF WORF O`J TNi.`; <br /> Phone:259�8�10 PROJFCT OVrq 9p pAYS DURATIOG. <br />