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Date r�oe�.wo��.vP,m�u '��" �/� <br /> BiJp Dept• _ <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT Pu1lo�fue��� • <br /> L�se�on.FeePeid S � <br /> pat�nreDun. S ��) (�"�'C�� <br /> Print or Type Onty <br /> lJo.��4� H�-/ea� C n�STe�< 2/O�s� Twc�- ; 7, ii�P-r/1"„o ���zvi � ,Sr �3�5` <br /> Owner Mading Address Gdy Zip Phone <br /> AppGcant Mailing Address Cdy Zip Phone <br /> Describe Proposed Work e�'�'�'� <br /> '{ 1 tI t e i�� F�Io�P/T��d g 9ie�rN � $r9C.�iA� lunt� . fUu✓� �i�!C <br /> yo 9..r � mCc . Lln.ilsc�/<<J i��.�`,'�� . 'Gtd, <br /> - W <br /> Prolect AdOress 1i1 knownl '��l �-`�, '� T l�ll�i S T, ~ <br /> Atfach lour(41 copies ol plans lor proposed H•orK- Draw to scale and note ihe following as applicable: � <br /> � Pwperty Lines • Centerllne ol slreet � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed u�ilities • Show mcasmements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspectlon shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shell be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Stendarde end Specificetions. � <br /> 3.pall Lecation Underpround Service 48 hrs.before you dig.TOIL FREE NUMBER 1•BOO-424•5555. <br /> f G.�� 7�/ feer� -� , <br /> � I � _%/.t � ,:.-�- �'/� l� lti" O <br /> � ' � � <br /> � JO � _ T ���.t.^z.��/ /� �/� <br /> / 7 ' A :7 , •.�.ta,�t' .��t'r,�:. � <br /> • °- ,� (" ,c'/�tvE��-�t`�z'" Y♦ <br /> � � _. � ��, <br /> ;l- � .��t��c.> .-�1:u= O <br /> i <br /> ) � I i) � ,,j� _,./ _'ICJ,:c/ . <br /> f j1 i7 <br /> lJ -� , . '�%3-IG�__ � <br /> �/r� i�; <br /> � i <br /> I �� � ACKNOWLEDGEMENT OF CONDITIONS <br /> ��P' �� .� .�� — ;�� , - The undersignetl owneVapplicant hereby agiees to hold and save harm- <br /> less the City ol Everett Irom any and all claims lor tlamages, costs, <br /> �,�. �J�.,�' �i��%' !<<�F"� eapenses, or causes ol actlon Ihal may arise because ot installation <br /> '7 ' and maintenance ol lhe improvement or other ngM-ohway use hereto <br /> �_ l,j _ <br /> �7�"����" ��'������ ;�pphed for antl lurther agrees to remove same upon notice Irom the <br /> qppwved lor Constructi� � Dale Ci�y and to replace public proPerry damaged ihereby. <br /> � ��0 ( <br /> r_ 3-� � ° ; <br /> �-'=�`' �,�.c�C`o�e /� ��•��>,�' �� 3_ <br /> AL INSPECTiOr. Date Date <br /> ADProved as Constructed ignaWre ol Applicant <br /> WORK AUTHORI2[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICwORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS �SSUED AND 7HEREAFTER IS TO <br /> � 3?OOCedar5lreet I BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY BE <br /> Everell.WA9B201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.259-8810 PROJ[CT OVER 90 DAYS DURATION. <br />