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--, <br /> 9/- i.�� ' <br /> Date 3F`g �� .-�._�,o��.sPa,m�:, �— <br /> Application For em�.��oi.r _ <br /> Pl3BLIC WORK� PERE1111T ��^�=W�«s�e� — — <br /> lolalFee S <br /> Lc<s Appl Fe�PmU Cu _ <br /> Bal�n<e Due S�S�� <br /> Print or Type Only —_ -- <br /> �UCI \ �C. l �.�MMUY��'��n i�`l�l^ .l InC_ I JW�� �\ '�11 ��LF�I� � Iv� J ���� IC��, <br /> Owner ailingA�dress City ip Phone <br /> , r�1�� �;; ���6� w� q8o � Z <br /> _ �Pa�� til ,�i�i�s�n -- �.�}2-5zc2 <br /> Applicant Mailin�Address City Zip phone <br /> Describe ProUosed Worf �> ClY' ��v•, `T� '�- �Q� Sq V�--1y — yr �, 1 � <br /> 1 il-��SZ�._ 1 _._r�� <br /> 1 'r 1 J ��11����-SV�6 � • _ __— <br /> _��---_-l3 - 4�-��-, st .��� _ �r <br /> Prolect Address�if known) � <br /> Atlar,h four�4) copies of Ulans for prnpose�i vnrk� Draw to scale and note the followin� a;zpplicable: �� <br /> • Properry Lines • Centerline ol slree� � <br /> i Ou':lire and dimensions of all existing and • Indica�e North <br /> proposed sin•ctures on ihe Iet • Show any pwposetl gradinc� chanyes <br /> • Existin� and proposad utilitics • Show measurements � <br /> DO NOT WRITE BELOW THiS LINE •>/� � � <br /> PER� iT CONDITIONS �0004951R ' � O <br /> 1.All calls for inspection shall be made 24 hrs.in zd:ance-phone 259-8810. � <br /> 2.All work shall be performed in accordance w�th this perm;;and current City of Everett Desi oW F Constr�iF o0.�� <br /> Stantlarc'sandSpecification,. � ��•U� <br /> 3.Call Location Underground Senice 48 hrs.before you dig.TOLL FREE NUMBER 1-��00•424-5555. � <br /> � ���1Ccnd-,U 4nuJ Mr,��p��u2� �'!to'ycm� C'Cn�c`( 22 � <br /> d�cf�I' f.z�d `�.� �c�e�e�c°� CrlozO�. d�<<.�i,,,r�tf� <br /> _� .X��r�r.c.fo � icrCQaA,,,c..-c�rl �d-�ta���f' � 4!c t�ac��t� � <br /> p,,, ,�lw �a1CR-oe' C1�itu.�.X�+ti' , � <br /> { � ,�,.. <br /> � /�/ /1 /J t'., � ,y <br /> 'VO C ��'i°�ir},� Q'� �'I�LC��i' P2.�eiL -�/�.i /_� �.. C L�'2' r_.;V <br /> Cl � <br /> �� �� <br /> .Coilj .z��w SE=Z'��c2cl-_� ��7�2c� �:-. �__. � <br /> ACKNOWLEDGEAIENT OF CONDITIONS <br /> Tne undersiyned owner/appliwnt hereby agrees�o hold and save harm- <br /> --� iess the City of Everett Iwrn any and all Caims for d2mages, costs, <br /> . j expenses, or causes of action that may aris..• because ol installation <br /> \ �/ � ? — Z Z _ f /1 and maintenance ot the improvement or other righbof�way use hereto <br /> r apU�ied lor and further aqrees to remove same upon noUce Irom the <br /> Anr�o or Cop ruct{on Date Ci d replac�ubli �l perty damaged thereby. <br /> / � <br /> � ` / _ �"�_�� � <br /> %l�� <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalu e of Appli an bale <br /> evere[t PUBLIC WORKS DEFARTMENT WORK i1UTHORIZE BY TNIS PERMIT MUST BE STARTED �VITHIN <br /> � 180 DAYS OF DATE �RMIt'IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street � <br /> Everet4 WA98207 BE DILIGFNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Nhone�259�88�0 CANCELLED BY THE CI�fY UPON ANY STOPPAGE OF 1VORK ON THIS <br /> � PROJEGT C,�JER 90 DA1'S �URATION. <br />