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��y� <br />0�1x <br />9HN <br />rr-i � 3 <br />f H <br />�H� <br />"�U H '� <br />NNr <br />t*50�H <br />OH <br />��g <br />> H LTl <br />i <br />t HH <br />y <br />gea� <br />L�tl� <br />H t�ii <br />H O tn <br />� <br />1 <br />I �� <br />I �� <br />�_�_ <br />Date `� — `-i , • _ _ <br />� <br />ppplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />, � A�J ,._c. `�i L� �.ii�._ __-. <br />Owner � <br />! ' /'...- 1 c: <br />! Applicant � <br />Describe Proposed Work � -� � <br />_ � .- r�;. �Li _��'_ <br />Address City <br />I,__; �C_il_ <br />r <br />Puoimwaksvermn• �`-�4`f' � <br />nma oew.• — . <br />v�ai�c wo��errc <br />,o�,��� s <br />�rssnnm rerr.��„ S---�� '�, <br />eaiT��a o�� 5 Nn141'1'1` <br />--.�%�_�;.L\T <br />ProlectAddiculifknown) '-1�.—'-� �' � _'.' �—r-L�='-' <br />Attach tcur (d) copies ol plans for proposed work � Draw to scale and note ihe lollowinc� as ap�licable�. <br />• Property Lines • Centedine of slreet <br />• Outline and Aimen,ions of all e•iSling and • Indicate Norih <br />proposed simctures on �he lot • Show any proposed gradinq changes <br />• Existing antl proposed utili�iCs q Slmw measuremenls <br />PERMIT CONDITIONS <br />1. All Galis lor inspec�ion shall be made ^.4 hrs. in advance - phone 259•88i 0. <br />2. All work shall be peAormed in accordance with this permit and current Ciry ol Everett Design and Gonstruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. beiore you dig. TOLL FREE NUMBER 1•800•424-$555. <br />for Consiruction <br />., ,.. . �..;ti „ _, _ <br />� r 1 I i . <br />I ._`` l �� I `��`'" <br />'_ . _�_. ._ ' <br />W'� <br />� ', <br />N <br />Yr i <br />O I; <br />� <br />Z� <br />O I <br />� i <br />N li <br />O' <br />a <br />ACKNOWLEDGEMF.NT OP CONDITIONS I, <br />The undersignetl owner/applicani he�ehy agrees to hold and save harm� �� <br />less the Cily ol Everett irom any and all claims for damages. costs. ' <br />ezpenses, or causes of action Iha1 may arise hecause of installation <br />antl maintenancc ol Ihc imGrovoment or other nghPobway use he�eto <br />applied tor and lurther a9rees to remove same upon notice Irom Ihe <br />Date City and to replace public pwperry dama9ed thereby. <br />�, FINAL INSPEGTION Date <br />� Approved as Consiruded Sionalure of ApPlicanl Oate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br />� 3200CedarStreet BE DILIGENTLY PURSUED i0 COMPLF710N. THIS PERIdR MAV BE <br />Everen, WA 98201 CANCEILED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />