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y <br /> I(�Z � - �`�n �,�_� '� Gg -{ � <br /> Date�i'�� " :,,��,,:.•��,...�,.,m��. ���ZSC•�— <br /> Applicntion Fnr ��aa oeo�.• �,�/�i ! �> _. <br /> PUBLIC WORKS FERMIT ruoToaFea�ep 5 <br /> lrsfAp01 feoPniO S <br /> e,i,��,.o��, s Z.b- <br /> Print or Type Only TO P(15Ti Nr__�i ��3 <br /> xr� <br /> �ay i � <br /> ��� � � , ����yt n�Q, ��n/,, -/� �G� �.cK'dCl7", �1���,f� .353-/12G� 7 <br /> a y y Owner � M"'�ing Atlaress Cdy ' �p Phone <br /> y �H <br /> O �O Applicant MailingAdtlress Cily ZiP Phonc <br /> '{1 H'�1 <br /> y �r ����� /2,h�/SF�v� /-�7D..�F rarrA J _ <br /> x 3 Descnbe Propo;ed�Vo�k � <br /> b7 O lT1 __ <br /> H C7 <br /> ��g W <br /> z H� �j3p� - 1 st A�e S� � <br /> y y Y Prolect Atldress(if known) <br /> � <br /> t f"�� Att.ch tour(4)copies ol plans for proposed work-Draw to scale and note Ihe fellowin9 as applicablE: � <br /> y ♦^ <br /> 1- • Properf>Lines • Cenlerlim;of slreet <br /> h d y • Outline antl tlimensions of all existing and • Intlicate Norlh V� <br /> � [�S r proposed slructures on Ihn lot • Shovi any proposetl c�rading chan9es I <br /> L'7 • Exisling antl proposed utililies • Show measuremems M <br /> H O C�/� � <br /> DO NOT WRITE BELOW THIS LINE O ',1 <br /> PERh11T CONDITIONS <br /> 1.All calls lor insper,tien shall 6e made 24 hrs.in advance-phone 259•8810. � I <br /> 2.All work shall be pedormed in accordance wi�h this p=rmit and curren�Cily ol Everett Dosi��n�nd Cansiruclion <br /> Standards and Specilications. <br /> 3.Call Location Under�round Service 48 hrs.belore you dic�.TOLL FREE NUMBER 1•800•424•5555. � <br /> � � <br /> � � O � <br /> � <br /> � e_� � <br /> �. '`� O <br /> 1 � I <br /> `1 ( <br /> ' `j ,.,(_,� ACKNOWLEDGEMENTOFCONDITIONS � <br /> �. y i he undersigned owner/applicanl hereby ag�ees to holtl and save hanm <br /> less Ihe Gty of Everett Irom any and all claims tor Aama9es. costs <br /> ezpenses, or causes of aclion Ihal may arise 6ecause ol instullahon <br /> !'.�' ��`r �_q_91 and mainlenance ot the impwvement or other nghl-ol�way use hereL: <br /> — _�j.,�L'}-eK ✓ applied �or antl �uriher agrees Ic rCmove same upon notice ��om inc <br /> Approve � ?ConsV cijpn � Dele Cily and to replace public prope':y damagetl thereby. <br /> r � / <br /> i' � � .. <br /> • " � "� / ! .../� , <br /> FINALIN PECTIO l ���� " ' <br /> App�oved as Construc�etl Si9n�1're ol ApPhcant, ���t <br /> �+ WORK AUTHORIZE� BY 7� �. eFMIT MUST BE STARTED WITHIN <br /> /�'m`� PUBLIC`•YORKSDEPARTMENT 180 DAYS OF DATE PERi. '3 ISSUED AND TFIEREAFTER IS 70 <br /> � 3200CetlarSlrcet I BE �ILIGENTLV PURSUED i0 COh1PL[TION. THIS PERh11T MAY BE <br /> Evcrott,WA9?"<01 CANCELIED�l'TIiE CITV UPON ANY STOPPAGE OF WOIiK ON TF715 <br /> Fhana:59�ON70 PFOJECT OVER"0 DAYS DUNATION. <br />