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r <br /> • � � ..� ✓�� <br /> Date � '� , . .. _�� ,, � <br /> ApPlicalion For . ..� • �� �� �� �� - ' <br /> PUBLIC WORKS PERMIT "��°��°w°��,�eB — � <br /> ,a,.��aP s <br /> ,.y,.�� i.�.s nom Fee Pem 5 .. <br /> uaiance Dua S <br /> ,p�x Print or Type Only -- <br /> C H <br /> 9 H tn <br /> r � � <br /> y �� ���1�`r�'11� ,';.='C���7 f�t,r'��::{� ��i _Y� " ���� C� -� �-, , <br /> � �"� � 1 ��9 —�—• - � 1 <br /> K y� Owner Madmg Adtlress City Zip Phone <br /> "�9 H��C <br /> cnH �_:� �1(G' — <br /> � O� Applicanl MadingAtltlress Cdy Lp Pl�o��c <br /> C+] [�1 <br /> H" � AL�IJI '�'(�l�/ <br /> � <br /> H �C Descnbe Proposetl Work � , ' <br /> 4)� O — <br /> Zy� <br /> ��y �y W � <br /> � Cy y Prolect Atltlress lil hnawn) ��'� ^�� rl�' �� � � <br /> � �� 4ttach four�4)cop�es ol plans lor proposed work� Draw to scale and nole ihe followinq as applicable� � � <br /> y� y y • Property Lines • Centerline ol streel ♦^ <br /> H O V7 • Outline and dimensions ol all e.ishng and • Indicate Norih N� <br /> proposed slructures on Ihe lot • Show any proposed gradinq chanqes j <br /> • Enisting and proposed utilities • Show rneasuremenis �/� � <br /> W <br /> DO NOT. LYRIiE BELOK THIS LWE O <br /> � PERMIT CONDITIONS <br /> 1.AU calls br Inspection shall be matle 24 hrs.in.dvance-phone 259•8810. � ' <br /> 2.All work shall be pedormed in acCordance with this permil and currenl Cily of Everett Design and Consiruc�ion � <br /> �,. � Standards and Specificalions. ' <br /> � � 3.Call Location Undergwund Service 48 hrs.beloie you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> ��li.�T f�"C�� �F� ��S—�9� � � <br /> {^ ' ��L J <br /> I' y N <br /> a �� <br /> � a <br /> ►�--, <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The u��dersigned owneUapPlicant hmeby a9rees to holtl and save harm- <br /> Iess t �e City of Evmetl Irom ary and all claims tor d:�ma�es, cosls. <br /> "`� �..! • enpecses, or causes oi aclion that may arise bewuse ol installalion <br /> anA niam�enence ol �he improvemen� or o�her nghPol�w�y u5e hern�o <br /> �ppli.�.d lor anA lurther a9ice, Io remo�e same upon no�ice Irom ihe <br /> Appwved lor Consiruction � Dato Cay.�nd to replace publm p�operty damngetl there6y_ <br /> RNAL WSPECTION Date �� <br /> Approvetl as Constructed S�qn�twe ol AnPhcant �atc �, <br /> WORK AUTHORIZ[D BY THIS P[R�dIT h1U5T �E STARTED WITHIN <br /> i•vrrcll PUBLICWORKSDEPARTMENT 1&0 DAYS OF DATF PERAtIT IS ISSU6D AND THEREAFTER IS TO �I <br /> � 3200CedarStieet pE DILIG[NTLV PURSUED TC COMPL[TION. THIS PERMIT h1AV�E <br /> Everel6 WA 98201 CANCELLED BY TH[GTY UPON ANY STOPPAGE OF 1NORK ON THIS i <br /> Phone.259�8810 PqOJECT OVER 90 DAVS DUf7AT�ON. <br />