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__ <br /> 'Ja�B/ < <' b7`� Pu�i¢Worxa Peimlt e ��'"`�`�� <br /> Applitation For fl�do.Deoi.• <br /> PUBLIC WORKS PERMIT PueTo�FaeFee , �� ,�� <br /> Leu Apnl Fee Po�E S <br /> /� a�a? <br /> Baience Uue S <br /> Print or Type Only � , <br /> �'<<�� �J�- � <br /> �� /� 9 r� <br /> j ''�ff7J/�i�7 �/t�G� l�% ��`,��'J Si�r/•Ll/. �1�> /=�'C'Kl�� G1/CiJ� �7����� .5 .>i.�165 <br /> Owner Mailing Address Ciry Zip Phone <br /> (� t <br /> C/` `,' Z H <br /> Ap4�icant Mailing Address City Zip Phone <br /> H <br /> Deacribe Pr posed Work f���'F�'x /-�5 C� �� ���`'��� nC ���C , � <br /> /ca i'.g,<Zv i�;9.('i�c.i.j� �Fi< < <o�:�i f� �i�'.�'���� <br /> —�, <br /> ..- f-i:G �sE���T c�" ,���l�' �.�'-c�EtiT / <br /> �t / �� � HH <br /> .���c ��i�< <n'� � y �n <br /> Prolect Address lit known) ��%�`�7� �S�L!�- �/%� �� L' //��- � � ' t~n � <br /> Attach tour(4)copies of plans tor proposed work• Draw lo scale ano note ihe lollowing as applicable: / � � <br /> • Praperty Lines • Centerline ol slreet �� y <br /> • Outline and dimensions ol all existing and • Indicate fJorth � � O <br /> proposed slructures on the lol • Show any p�oposed grading changes � <br /> • Existing and proposed utilitie� • Show measuremenis � <br /> DO NOT WRITE BEL�1W THIS LINE z <br /> PERMITCONDITIONS O �y N <br /> 1, All calls for inspection shall be made 24 hrs. in adv ince-phone 259•8815. � K � <br /> 2. All worY,shall be pertormed in accordance with this oarrnil anri current City of Everett Design and Construction � <br /> Standerds and Specilications 'n <br /> 3. Call Location Undergrountl Service 48 hra. hefore•:ou dig 70LL FREE NUMBER 1•800•424•5555. � y <br /> '/ [*] H <br /> 7. /�L�7y/!�i/�C cocf,'!�.'�";i>,���'T �G,�'c:���.�'�_� .!/fy'c1' tn <br /> �c i�:�i�Ji�� �sf�.�,._-<��.<< �'c��'li�- il.�o T O � � <br /> /T cy�cr���-tU_ N/� � <br /> S. � �/.f'c_c`T.c�� Y/ <br /> c=.4.zJYon� C"cn„i�F'c�!_ u%ic� ��_ /,�-�J H <br /> .�J/ //+'S/"'l_=� ,"L,�'. ,Scc�G� .,S'<��_�/�/1,��!?Jk-/%'iit��1.—_ O � <br /> � �� <br /> �c.TT7%�.c=i� ` �y �/!/-�S N <br /> H <br /> Hn <br /> ACKNOWLEDGEMENT OF CONDITIONS M <br /> The undersigned owner/applicant hereby agrees lo hold and save harm- <br /> less the Ciry ol Everett trom any and all claims lor damages, cost:�, <br /> _7��=, i- expenses, or causrs ol action Ihat may arise because of installahon <br /> � . �-�'i-�- -+ and maintenance ol Ihe improvemenl or olher right-ol�way use hereto <br /> �� '�- " +� ��f� / '"� ` `r�, applied lor and furthe� agrees to remove same upon notice Irom lhr. <br /> Appfo�or C nstruc n Date City and to replace public properry dama�.. ' Ihereby. <br /> ` �-Z7 -CJ�v � :. . <br /> � <br /> i �'�.'(�'��( <br /> FINAL INSPECTION Date � ' "-'�l�"�" <br /> Approved as Constructed Siynature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT � P10FK AUTHOi71ZED BY THIS PERMII MUST BE START[D WITHIN <br /> 0 3200CedarStreet 1B0 DAYS OF �ATE PEHM:f IS ISSUED AND THERf_PFTER IS TO <br /> Evcrett,WA 98201 OE DILIGENTLY PURSUED TO COMPLETION.THIS PEHNIT ia.AY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />