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,�/'—� �i Pueiic Wcrb Parmn s <br /> ,�Y�� <br /> Date�� I ��� _ <br /> B1ag Oept�.g'y /j, <br /> Appl;cation For _ <br /> PU�LIC WORKS PERMIT °°"""'°",F`a S��� <br /> lolal Fee <br /> �� <br /> ��y lass Apol.Fco Pai� S <br /> [�' <br /> [�J Baianca Duo s ���� -- <br />� .o�� PrintorTypeOnly ��-�� �6?7v0 <br /> Cy' H <br /> >H Cn <br /> � Z n � , , -, _�< ; :� <br /> yz� rc � / a �35"� l=v� �zrii y2zc � .. 5i 1 _ <br />� K n MadingAddress Ciry Zip Phone <br /> O x O Owner <br /> �sJ H KJ <br /> y G�r M RoN ��. Cr c�F�!_ �:.. i�`K i� i �� �r Fc 7 1 �/hone Z I .( — <br /> p /�D: lSui- (/Y9 �'' l__. <br /> x z> ppplicant MailingAddress ���Y Z�p <br /> LT7 C LTJ <br /> Hl7 <br /> � ' i�i<i ' `iFl= L �Cl.>f. 11D�7� / �� 7c5� ��ir.� �' TiZ L .•�_ <br /> i � �� Describe Preposed Work � K ^ <br /> f H y � �:.l / I n/Iv C FYy` 7 / l.T S R '�' (- ✓�/7 L= %'l-� _ /�—_ <br />� > H L 1 ST �i��--�'i ��—�c G CL/- //�%/�c,��-� . <br />� r ri H .— � <br /> O d N Project Address p� known) _ ���'s— "�� �`J � � <br />� � �r � <br /> [�7 Attach lour(4)cop�es of p�ans �or proposed work• D�aw to scale and note the follcwin9 as apphcable: � <br /> • Property Lines • Centertine al sireet <br />' H O p� • Indicate Norlh <br /> • Outline and dima -ns ol all existing and � ghow any proposed grading changes <br /> proposed stru�tures on ihe bl � gho�+meas�rements � <br />' • Existing and proposed utiliUes <br /> � DO NOT WRITE BELOW TMIS LINE � <br /> PERMIT CONDITIONS <br />' 1. All calls lor inspeclion shall be made 24 hrs m ativance• phone 259•881 5. � <br /> I '� a 2. All work snall be performed in accordance with this permi� and curreM City ol Evmett Des�9n and Consiruction <br />� �� Standards and Specilications. � <br /> I3. Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> 0 � <br /> —� � !'�� ��',��✓�=� .���•�zs� ��,� .s��Y <br />` � <br /> a� � <br /> !ti � <br /> � <br /> � � ._ <br /> ACKNOWLEDGEMENT OF CONDITlO�^i5 <br /> '� � <br /> ��� The undorsigned owner/applicant hereby agrees to hold nnd cave i�.ainr <br /> _ less lhe Ciry ol Everett Irom any and all claims for dama9es, costs, <br /> � �. �-, " eapenses. or causes of action that may arise Uecause ol installation <br /> �� � and maintenance ol lhe imp�ovement or other nght�ol-way use hereto <br /> " 1,,,.�s�� � � ,� J applied for and lurther agrees to remove same upon notice iroru the <br /> pppr A ruction Date Cily and to replace public proPerry dama9ed thereby. <br /> \ /� <br /> L%%i%1/� /-i-�l-f ///� ,'.e / " _.0� .S �' <br /> FINA NSPECTION Uale (��t-6 � �, �� �L� -T�� <br /> Approved as Consiructed <br /> Siqnature of App icant ��e <br /> WU,��1( AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett I PUBLIC bVORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ced�r Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS P[RMIT MAV BE <br /> E'+erell,WA ?0201 CANCELL[D 3Y 11-i[CRY UPOt'ANY STOPPAGE OF WORK ON THIS <br /> phonn; �;;�9-E3E'6 pROJEGT OVER 9D DAYS DUR�1"ION. <br /> � <br /> '_.___-,_�.�__— '. _ . _ .,o ..r,.' .'-.'_ <br /> . . - _ . .. . _ _____ _ . .-.. . In:.,. ..�`�a- _ �-a �i : <br /> . _.__... ._. ..._ . _._�.._ .. . . . . . .. ;. ... : " 1 <br />