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r - <br /> Date `�3 a�m<wo,ksac,mn. $3 1 L % <br /> Application For <br /> eiep.oeo�.� <br /> PUBLIC WORKS PERMIT PublicWorhaFee 2U . � T <br /> To�a�F�« s <br /> Leis Appl Fee Pal� s a�•O O <br /> ' Print orType Only ee�a�«o�� s <br /> �C�ar�te 4 C$nrbnr.. (.�n�wia.._I12...� W. S,Iver ll� Qol Evi-. �lt�.o S� 337- `Soo <br /> Owner Mailing Address City Zip Phone <br /> Sa..-�. <br /> Ppplicant MailingAddiess City Zip phone <br /> Desc�ibe Proposed Work Oav� G�'���n�� w-�J/ �.+.rn��� ctrt+,�+aai Co,.-+� � <br /> � <br /> ProiectAddress�ifknown� �—� S�ly�� �K ' � <br /> � <br /> Attach four(4)copies of plans lor proFosed work- Draw to scale and note the�ollowing as applicable: � <br /> • Properry Lines • Centerline of etreet � <br /> • Outline�nd dimensions of all existing and • Indicate North <br /> proposed sVuctures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT VJRITE BELOW THIS LINE O <br /> PERMIT CONUITIONS <br /> 1. All calis for inspection shall be made 24 hrs. in advance- phone 25��•881 b. � <br /> 2. All work shall be performed in accordance with ihis permil and currerl City of Everett Design and Construction <br /> Standards and Specilications. <br /> "3�. Call Locat1ion UnIderground Service 48 hrs. belore you dig.TOLL FREE NUMBER 7-SOO•424•5555. � <br /> y. �v��i.�.cX' i�e (ivw�-c�.r �+p't �:tS`i- t'l0z�.� � �oc...+l,� ba1-�. <br /> � fGS�� �w�� lv�a�G! SCf V�ct 3„MJ� -O� �J0.IV C H�r�� /� O <br /> � �1�!_ ^y �Y"P� U0.IVG� WN\(_� M�vL1� bt Re�.�N.SY'r`Y <br /> � �/�/ �/ , � <br /> � �rR�re p� �or -�o �a., �.�� . <br /> S. R�1 �QV ��1\ R'� �Oc; 1N1�0.���Y y., .`Fin\.1 �G �W w�N-�� bC � <br /> e� ,�...J.... .v�.�w� U (`� o�.�� 1,�,„,��� � f� .S. �IS�� 3wti�� O <br /> Nn..,.�a� bn :`..Y�1-..�I..S� �-�-u1 �1M-e se��•s-�-n.e.:�o.-, a.(t�- `�!-e. <br /> 1'.,�a�ti �Nor�� �v�3P�ctOr 7T� Cio++o� rOnsYwn� qYn�w.�C, a <br /> 1� � �- h Qa�b� Ca�� (3c�r��. 7 /� <br /> �O. A,. u,,.-+Y•--,P►o.�1..9 dr�tF:. P,� �n \ '� bl �KS�h2�� r..Sl ..,K.•►- b� <br /> 7 �P�„�9 b.� �-k� P1.—�.b6� 1.��.k9d ,ACKNOWLEDGEMENT OF CONDITIONS <br /> Ns C�O/ f10/ �+ INS`������o <br /> �' e P The undersigne�owner/applicant hereby agrees to hold and save harm- <br /> — less the City of Everetl from any and all claims for damages, costs, <br /> -..��'sy/ erPenses. or causes ol action Ihat may arise because oi inxtallation <br /> 6/�j and maintenance of Ihe improvement or othnr righFOFway use hereto <br /> applied for and luriher agrees to remove same upon notice Irom �he <br /> � prov d�fot Construction Date City and to replace public properiy damaged thereby. <br /> � ' � "�{�-�-�vi A�� �/ Z S��_ � �� - <br /> — r-wnt NSPECTION��.—T Uate �-(' - / ' � " ti- � �3-�3 <br /> �pproved as Consir��i@d j �� Signature of Applicant Date <br /> everett PUBI.IC WORKS DEPARTMENT WORK AUTHORI2ED Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl.WA 98201 BE DILIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CITV UPON ANV STOPPAGE GF WURK ON THIS <br /> I PROJECT OVER 90 DAVS DURATION. <br />