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_ � <br /> r .� <br /> 1 <br /> r <br /> �/ ,�.3 � <br /> Date r�m��woix.vermu. <br /> B�ap.�eo�-• <br /> PUBLIC WpORKS PERM ��jdJ fle <br /> PUELc Wods iee <br /> TolalFea 5— <br /> Lese Apo��Fen PeiC S <br /> rae�,��,o�a � *� <br /> Print or Type Only <br /> LQ,t�,+�e .'.ZJ?-�n' J <br /> �\aE�,r�I�� � �c�r �roc�se �4�33 � ����e�K'��j� l. i ��we�l1 i�2[/ �5�.-oy6i <br /> Owner� Maihng Address Gry ZiP Phone <br /> �5¢r�N rs 2 ��n✓ �. <br /> Applicant Mailing Address City Zip Phone <br /> rin� 1 n � 1��<��r" Nc'rm ✓�4.r��G Na•l�c: ct.� rer�.- <br /> Describe Proposed Work � /� <br /> O`s �Yt��jl r7�1 C��l C2 i � `i� �� CCYO`S �fr�/� �i � Cl.�iiriPre�ie..�� l':� <br /> rTl t' C �/IlT f� i✓ lJCl>7� LG/�f��i'Ei .b�t���7E'r«(� c C-✓e G!� <br /> ii� c�r g.Q � /��-�t/Pn`f �o�c� ��� �St Uo�cr�r� ��^ � <br /> � � <br /> Pmject Address(if known) <br /> .v a � � ,R_ �� n�_ U�re-� )n. �7�� <br /> , � <br /> Attach lour(4)copies oi plans lor proposed work-Draw to swle and note the�ollowing as applica6le: � <br /> • Properry Lines • Centerline ol streel <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Existing and O�oposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW iH15 LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall he made 24 hrs.in advance� phcne 259•8815. � <br /> 2. All work shall be pedormed in accordance with this permit and current City ol Everatl Design and Construction <br /> Standertls anA Specilications � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> �+-u.`l-�1 � c�i i��r;t.�.'�f l �. .ui E_ . � :iUc i-�'� O <br /> q4>33 . <br /> \ k�c«se. � <br /> ��� E � <br /> �. �-rat�o — � <br /> � � `�` }� O <br /> `m — - St�'er� h�znk � �c.zev ��a✓r, lc ciny�'�, u.�' �' A <br /> 'O n Ii <br /> � 5� LLIPiY�E� �J Gr d� ��1� ��nn��r�� � ,� , <br /> �" ./� Cc4'���°. �![I7P <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicent hereby agrees to hold and seve harm- <br /> less Ihe City ol Everelt irom any and all clalms tor damages, costs. <br /> I � /� YV expenses, or causes of action that may arise because ol installation <br /> and maintenance ol the improvement or other righ4of�way use hereto <br /> �'�' 0 applied for and fu ther agrees to remove same upon notice from the <br /> App�ove or trucli n � � �e�e C�ty and to repl e public property damaged ihereby. <br /> � �lo�'� �"b� ' l — — ,y��.�.�5�.�.c�.�,,, ��i��3 J <br /> FINAL INSPECTION �a�e Date <br /> Approved as Conslructed Si ature I plicaM <br /> WORK AU ORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSULD TO COMPLETION.TfiIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> 1 Phone:259�8815 PROJECT OVER 90 DAYS DURA710N. J <br /> L J <br />