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��.1 �„oi�c wm�a v����n. <br /> Date� U � � <br /> B�ep Deo� • <br /> qpplication For . <br /> I PUBLIC WORKS PERMIT °°°��.��e�"° 5 <br /> I less noo�fce Pmd S <br /> y n� Baiance o�e $— <br /> Cs1 Cs7 <br /> > Print or Type Only <br /> D R1 x <br /> � y y � � r , ,,� � r= a a/i 9�'�n, ,�s� �-� �Q -� — <br /> /IM 1 l/Ul�N � / � <br /> N �3' ��r u � u�" �)fi/' ��� --._.r--�� C IY Z P Phone <br /> H x M ' Owner rviauu���w��� <br /> �C f� <br /> H�1 <br /> O `uC0 <br /> � N H Mailinc�Address C�ty Zip Phone <br /> � �� � APPhcaN <br /> (� � , n ..c�,��/� ��� � , h���� <br /> p� �d Describe Proposed Work ��L�i� �Z <br /> �/� �g <br /> y�Y C] <br /> zy� W <br /> x � ` <br /> r-i y ) � � <br /> y Prolect Address lil knownl -����-+�� '� r ��{ r <br /> H <br /> C]C7[� �1 <br /> �C � Attach four(4)copies of plans lor proposed work�Draw to scale antl�ote Ihe following as applitable: � <br /> �� • Property Lin^s • Centerline ol strcet <br /> yH� • Outline and dimensio�s ol all eKisling and O Indicaie Norih <br /> 0 proposetl SlruGureS on Ihe lot • Show any proposetl 9raAing chanyes <br /> • Show measuremenls M <br /> • Eaisiin�j and proposed ulililies W <br /> � DO NOT\NRITE BELOW THIS LINE �\ <br /> \I <br /> PERMIT CONDITIONS � <br /> I1.All calls br inspection shall Ue matle 24 hrs.in advance-phone 259•8810. <br /> �� 2.All work shall be pedormed in accordance with this permit and current City ot Evereli Design and Gonslruction <br /> Standards and Specilications. � <br /> 3.Call Location Underground Service 48 hrs.belore you dig TOLL FREE NUMBER 1•800•424•5555. � <br /> � / � O <br /> I � _ �- r1 � . , . , .:� - .I '; . . . 7/ '¢�C%2, .��c.o G'..ti,�7 , , . . <br /> ��� ����" ' i . f L � <br /> /� �/ S � / � �T "L. � <br /> '� C ��"�(<'!"l� ��Z:l%�I' Ci(l .C� �l��7"lf.� f)l ��![Cl� Z�.• i � <br /> ✓' ) <br /> � _'f �.�7`w. 3'-��iu S�.cc.�nit— /•,� ��r.�v( l'.w� 2 .5..�... <br /> p ��. flCf „ /.�' ,-vt<d ,Lt ��,���iCl�ii ��- I r�� O <br /> .� i .�<: 'G!(ns✓ ,6�'L) � � <br /> �� � � �'- !<�:�.G�/i.. (,,h�' <br /> � ;( ti, , r���('' �- <br /> / �� ` rl '" <br /> I � '.�i;/. .. <br /> . J.. '/.' _%,�. <br /> '_ ACKNOWLEDGEMENT OF CONDITIONS <br /> �� <br /> The untlersi9ned owner/apPlicanl hcreby agrees to hold antl save harm� <br /> less the C�tY oi Everett fmm any antl all claims tor dama9es, cosls. <br /> e*pen5es. or tauses of aCGon lhat may anse because ol inslallatlon <br /> and mainWnance ot Ihe impro��eJ�ent nr other righPol�way use herelo <br /> app�ied lor and lup iT�-r ac�rees To remove same upon notice Irom Ihe <br /> APproved br Construction Dale Ciry anA to repl�fe p��P� eriy dama9ed Iherehy. <br /> ��� <br /> �;�, 7 /` D <br /> Datc '' <br /> FINAL INSPECTION Signalure of Applica � '�� <br /> App�oved asConstructed WORK AUTHORIZED BY THIS PERh11T MUST �E STARTED WI7HIN <br /> �evcrctt PUBLICWORKSDEPARTAIENT 1B0 DAVS OF DA7E PLRMIT IS ISSLIED AND THEREAFTER IS TO <br /> 3200 Cetlar Street Be DILIGENTLY PURSUE�TO COMPLETION.iH15 PEFlMR tdAY �G <br /> Everetl,WA 98201 CANC[LLED BY THE GTY UPON�1NY STOPPAGE OF WORN ON 7HI5 <br /> Phone'259-BB10 PROJECT OVER 90 DAYS DURATION. <br /> I <br />