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• �:...v��.�ar'�,. - - - ; - "' ., I <br /> �" ..,.. � — <br /> � <br /> �� � PuEuc WorU Parmit• /� /�� <br /> Date �� � � <br /> eiac.oam.• Q/— 2 G�k 13 <br /> r., Applicetion For <br /> pU�IC WORKS PERMIT ��oi�cWonsiee s <br /> Tol�l Fee <br /> Lecs�oG��Fee PnJ S ^�� <br /> 05 v� S � $ r�5 e.i.�«o�a s ..3/J � <br /> Print or Type Only� ; � � �� o � <br /> � � M N J � <br /> � � <br /> .ti I^+ ++' � M � "� <br /> PQ.'T C�F �d- !' - Phone <br /> i np, �s City Zip <br /> Owner � � � -� � <br /> � � <br /> � c�:° .I�,��� �i - L,4 Cc,�,vrf�: ��,o J.c�_S7 �l,G – 3//�f <br /> �i�/CFf� Tok�/N!r Z�p Phone <br /> Applicant Mailing Address City <br /> Describe Propoaed Work <br /> /�eLccnf� lJi+�=�' h��'�•, rrpUncl ,f�rapn5�� <br /> fjB�,fa!' �li�ifi . <br /> W <br /> Prolect Address(N known) <br /> rJirY'C��!/�i"C� .. .3o�1D �urifh �cri.,.i-„ �ar � <br /> � <br /> Atlech lour(4)copies of plens for proposed work•Draw to scale and nole the following as appliceble: � <br /> • Property Lfnes • Centerline of street <br /> • Outline a�d dimensions of all existing and � Indicate North <br /> proposed siructures on lhe lot • Show any proposed grading changes <br /> • Exiating and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cells tor Inspection shell be made 24 hre.in edvance•phone 259�8810. <br /> 2.All work shall be peAormed In eccordance with thia permit end current City uf Everetl Design and Cons;ruction <br /> Standarda and Speclflcationa. � <br /> 3.Cell Location Underground Service 48 hrs.before you dfg.TOII FREE NUMBER 1•800�424•5555. <br /> S/, /l.b�',t Tu �'f' Do�✓,� �.s c R F,v i�1T.�'�,f�F– D. � <br /> 1 ' ' fid•�+n <br /> S. �A/��Ie/n :Z N�ii�inoarrv a� 20 O� ��QninnCC C' f. <br /> t�hC /�e�✓ �•/n+�er ��nin �otifion ..,</ r�/S�_• rDio�nscd Gnr,fcr �cil�Y• � <br /> 6. fI« u�v,c,r Si;A�c ,BF n�,v� tiE£ �•ry oF £vE,�E� .S�'P.niOi,.�OS, � <br /> r �t/ ASr�ui�T oF Ti/c' �vArE�' h�F�.s/ /S ,C�'Av�.�'EO %a �'E O <br /> .SUcn:i7%F"/� w THE ��f� Lt/iTNin/ 3t� ./nf.s f3l��� �fh� � <br /> /�✓S!�!!olin., /S �cr^�)Cc 1� . <br /> B. A /S '�,��o_r• Fi��FmE.✓T ?n 7x�f �iT� f'o,c TaE NE�✓ r✓j0jf� <br /> ,c�� p�.,t T. <br /> ii/AilJ LOCf��� �'��"JT j'E PF'O✓/V�U 'Y H� ACKNOWLEDGEMENTOFCONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from any and all ciaims for dameges, costs, <br /> ezpenses, or causes of action thet may arise because ol instatlation <br /> � / ,t� 2nd maintenance of the improvement or other righfol•way use hereto <br /> (.����vc��/�ti- ✓ �� applied for and further agrees to remove same upon notice trom lhe <br /> Approved tor Cons ruction Date City and to replace public property damaged thereby. <br /> � ` <br /> FINAL 1•'SPECTION Date Date <br /> Approve�as ConstruCled <br /> Sit natura of A icant <br /> WORK AUTH IZED BY THIS PERMIT MUST BE STARTED WI <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreel 8E DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet4 WA 98z01 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAVS DURATION. <br />