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i <br /> Date -' 'l' � �l v��nuc wmea no�mn� �/�T <br /> l3inq oent . <br /> , Applicalion For <br /> PUBLIC WORKS PERMIT P°°;o,w�P�`^e s <br /> �ass nnni Fne vn�n S_ <br /> �eianr,oDun S -�� �C <br /> Print or Type Only <br /> II� ' '/ C�'!-r!>� `�G/7-S/LtE�PTP lAN,E' r'<%�iT f�3'��3 w5�- /r�n <br /> Gwner MaJing AAdress City Lp Phone <br /> ,��i»F — <br /> Applicant Mai�mg Address City Zlp Phone <br /> Describe Proposed Work _ �n�''�'c�'r> .9 F/�i�C/" /N TiYE /Tf� ,t7/!r//j- <br /> OF- (C A!/ ! <br /> i � <br /> y�/7- cSi�c;CKTi� C F. Ato.✓b ' tEC.✓ F,Pn.vT �c' � � <br /> Proir.ct Address lil kaown) � H � <br /> Attach four(4)copies of plans lor proposed work� Draw to scale and note the lollowing as apP���able: � 1 <br /> • Properry Lines • Centerline ol stiee� ♦w I <br /> • Outline and dimens�ons ol all existing antl • Indlcate North V� � <br /> prOpoSed SirucWreS On Ihe lot • Show any proposed grading change5 � <br /> • Existing an0 proposed utilities • Show measu�ements M <br /> W <br /> DO N(�T WRITE BELOW THIS LINE a <br /> PERMIT CONDITIONf'i <br /> 1.All calis For inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be peAormed in accordance with this permit and current City ot Everelt Design and Construction � <br /> Staodards and Specitications. <br /> 3.Call Locetion Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � , <br /> / OFir,vc,� r,os-r Pf H �,>,.���.»�m nF .3 ��i,�c,r fti�cri� <br /> T//E FOC• _F �F f'�'vi.'�C'r. <br /> 5 F-l'N[� ��IUST B� /�E/���FD A� Ti/E UC✓n/i=.�'�S � <br /> Ex/��NCF_ /N TyE El�•'Ni j�,lqT Ti/E C�� � � <br /> �,'C_FOS To Da tdn,e.r [v.r��ini 7i+w�J y,��t��.�J Q <br /> �F rE �',c-,,;-oF-<<��y. ' <br /> �-F�,���,�����,��.�-,-�--i�� � a i <br /> 'y�fii�+t'�—A�-T�tF S!)UTN-�9ST _Lc�Fy��E ' l+�--�fb---�1���a 1 <br /> l}Licp-rss--Ef3�_C.fF_Cc1S ��t['�jS`�1+�f��'���a� • I <br /> ACKNOWLEDGEME�IT OF CONDITIONS <br /> The undersiyned owner/applicant hereUy agrees to hold and save harm� ' <br /> --- less ihe Gily ol Everetl from any and all claims tor damages. cosis � <br /> j eapenses. or causes ol action that may arise because oi installatior . <br /> 3 _ i�9 . and mamtenance of the improvement or other righl-ot�way use herett . <br /> applicd lor and Wrther :.grees to remove same upon notice Irom Ihe � <br /> A 1Qved for nst tion � Ciry an o replace pubf ,pr � r da;naged �hereby. <br /> ( �� dre �� � y� /���1�/(� " � j� `����9G� <br /> FINAL INS C N � 1e � Date <br /> Approved as o uct••d �� Signa�ure ot Applicant <br /> C-i-J����� WORK AUTHORIZCD BY THIS PERMIT MUST BE STARTED WITHI� <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DAi[ PERMIT IS ISSUED AND THEREAFTER IS TC <br /> � 3200 Cedar Sireet BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON?HI� <br /> Phone�.259�8810 PROJECT OV[R 90 DAYS DURATION. <br /> v <br />