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.�-_.... <br /> D6t@.�1L� ' r�eiKwo...v.,mn• gS— �'S`�. <br /> Application For eieo.n.p�.. S 0� <br /> PUBUC WORKS PERM�T PUbTo1�Y�F� . <br /> La�f A�p�Fw P��tl S--.�— <br /> Print or Type Only ������°o�a f � y <br /> yya3� �4.��.� <br /> �'��������<<�1�,����� ��.����� • <br /> Owner M iling Ad res City Zip � Phone <br /> �s.���omay �ec��24� ///1 r� -� . �tf1�G��•y�/D/ /��O <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work n � �� � �_ <br /> � � <br /> W � <br /> Pro�ect Address(if known) �3.?.3 — Sld�LC � Gj'c i/D, � <br /> Attach four(4)copies of plans far proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol sirr,et ' <br /> � • Outline and dimensions ol all existing and • Indicate North N� <br /> proposed ctructures o�i ine lot • Show any proposetl grading changes <br /> • Existing and proposed u�ilities • Show measuremenis � <br /> � <br /> j DO NOT WRITE BELOW THIS LINE <br /> � FERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs.in advance-phone 259•881 5. � <br /> 2. All work shall be peAormed in accordance with Ihis permit and cu�rent City of Everett Design and Consiruction <br /> ;�� � StandardsendSpeciflcations. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TULL FREE NUMBER 1•800•424•5555. � <br /> � �/ /�'8 �a.c.r.wc(� Sa<<s ifF:E' Si�a«.r/ c.0 f'�d�1_i, <br /> /S'2 Po,c�,e,:vli Sr�«s u�E._�� f3�r.s�csE/� �v.�vn/tr O <br /> SEi�A f.'Cv.E�cJ. <br /> E.�s,�d P.ai.:G.:r/cr ivi�L dE .PE�j�v�.�ED ��v f'.voS:II � <br /> /F %✓.c n/c�in/�E� OF .Si'aG�'S �i�:SS� OcaE"S NGiT � <br /> T�.e.� cwr Tn BE' A��rde� Fa.e pyas< I. <br /> �r-�E.� t��div..li.�lr D_<.�.-� _ dC•a' Ca�vOiE� O <br /> s ;o �f-' <<�vs;����r-o �E.�� �.�.,._�,�•r:_� a <br /> .�� a us i)�,-�i� ,-�/�js,u. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less �he City of Everett irom any and all claims br damages, costs, <br /> expenses, or causes ol action ihat may arise hecause oi installation <br /> �. ��jC���_ �j�n� and maintenance ol the improvement or olher righbol-way use hereto <br /> ;�J applied for and furiher agrees to remove same upon notice from the <br /> Approved foi ConsVuC' n � /Date City and to replace public properry damaged ihereby. <br /> ' G `�J _ ^`y/. '/ rl <br /> ..-INALINSPECTION Date � '-LrL�� ,R"1 �C��� � I� t�"S- [�J <br /> .pved as Constructed Signat e of Applica� / � Date <br /> � PUBLIC WORKS DEPARTMENI WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 1B0 f1AVS OF DATE FCRMIT IS ISSUED AND THC-REAFTER IS TO <br /> 'vcrett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> •one:259�8875 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />