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LZ b � / 7 %"�_ �,,,ei�cw�,.,nr�m�i. /'} T�!"�._ . <br /> � Date��' ` _ <br /> �7 ❑ixi�eni r <br /> p� C Appl:wlion For __ <br /> � " y PUBLI'� WORKS PERMIT `°°r�w�Fea"` g <br /> N � M 1 esf POYI fen Pa�E S ,7���5--- <br /> � BtldncO�uP 5 <br /> � � � Prin� or 'fype Only 0� Z� 3 ��y0� ' <br /> � � � �„ � 93/ <br /> � �, 3cx ��' Llt sTf-��<<<� ".�.,t;�� >�;�� �<�'�7 <br /> �"� � gg /� r M�ling Address City 7in �'hone <br /> � • � ner <br /> H <br /> y <br /> ����� C IY Z p Phnne <br /> pp y H qpplicant Mailing Atltlress <br /> n O N ` � � '— <br /> � � � � � "— _ ' c^ �� :('I/ `. f_ - <br /> � Describe Proposed Work <br /> y L? ��� /C � / �J'.L'� I�/'� SPcv�ic A/iCJ <br /> W <br /> Proiecl Address lil known) <br /> _-E�� � 1` �,�•�<��e � �i�- �U��z,,�- � <br /> � <br /> Attach four iAI copies of plans br p�oposed wo�k� Draw to scale and nole Ihe following as applicable: � <br /> • Prop�rfy Lines • Centerline of strect <br /> • Outline and dimensions of all enisting and • Intlicate Norih <br /> proposed slrucWres on Ihe lot • Show any p�oposed gratling changes <br /> • Existing and proposed utilitics • Show measuremer,ts M <br /> W <br /> DO NOT WF:T[ BELOW 7HIS LINE O <br /> I� PERMIT CONDITIONS <br /> C�� 1.All calls 1or inspection shall be made 24 hrs.in advance-phone 259•8870. � <br /> . 2.All work shall be pedo�med in accordance with this permit and curre�t Ciry of Everett Design and Construction <br /> 1 Standards and Speclfications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> , !� r1 <br /> —' T /)QS�o%C .�G�� ^^' GtlLc�-c^���c.(� Coxc/; l :crr�� . O <br /> 5, �ci+„Y �4,MR yG/ .� �(1��� .].t Cc 4 .- .�l[[..a � /LC <br /> � �_� ��`���. �� ��6� �_ �.,.! �— <br /> � � <br /> ��_� a <br /> � <br /> �� , <br /> ACKNOtVLEDGLM6NT OF CONDITIONS <br /> � ' ' The unde�sie�nr,r1„wner/applicant hereby agrees to hold and save harm� <br /> � '=t�' �___ , less ihe Cdy of Everell lrom any and all �Iaims �or damages, cosis. <br /> Ie�penses, or causes ot aclion lhal may anse because ol installation <br /> l\ �/i� ✓� /y antl mnintenance of ihe improvemeni or other righ4obway use hereto <br /> ���rrlli appheA br . d furiher agrees lo remove same upon notice Irom ihe <br /> qp�.rove �oi Construcii ,� Date City and re lace public property damaged thereby. <br /> �C���/_ r� �" �. l%� /,7 ' 1 3 -%L � ���� � � ��Z_ <br /> � G� Da�c � <br /> RI:4L INSPECTION igna�ure ol ppll ant Oale <br /> 4pproved ns Consiructed <br /> �-� WORK A f71ZED BY THI ERMIT MUST B[ SiAPTEO WITHIN <br /> �� � PUBUC WORKSDEPARTMENT 1B0 DA OP DATE PER611T IS ISSUED AND THEREAFTER IS TO <br /> ��,:/ 3200CedarSireet BE DILIGHNTLY PURSUED TO COIdPLETION. THIS PGFMIT MAY BE <br /> Evercit.WA98201 Cf�NC[LLED BV THE CITY UPON ANV STOPPAG[OF WORK ON THIS <br /> Phr,nc'.259�H010 PROJECT OVEfi 90 D��S DUF��T�ON. <br />