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,� <br /> I <br /> I <br /> I <br /> v' <br /> UafB�i�`-,��' � ` _ _ <br /> • n„mi�cwo,wsr„����i, 8 9 -'-L"� <br /> APPlicatien For am� oeo�., _ �.�_�_. <br /> �UBLiC WVORKS PERNlIT P�����=W�,����� -- -- <br /> ,�,,,F�� 5--- <br /> �ess Anni Fee P��m S__ __.__,_ <br /> eaiance Oue 5 �<�'_ `� <br /> Print �r Type Only _ _ __ <br /> �.� � ,�P,,-,.�, ror, ��.c�i-� �,��r�P_ �3��� �Ub,�i� ��%a �� _ s� ., <br /> Owner � Mailing Address ��� � � � �'""2"'�----�--�-- <br /> Y ZiP Phaic <br /> So mC <br /> Applicant Mailing A7dress City Zip Pho�z � <br /> Describe Proposed Wo�k � �1� <br /> �/�.t,�f�[�-�.n-.�,1�� rPs��a� � ��_��c���h,,��„_,,° <br /> �. <br /> — -- -- --_ �i <br /> - — ��— -_ - � � <br /> p� 4 i.�"Tli �� , 5.lJ �` <br /> Pro�ed Address(ii known) !��' _ __ �, <br /> �� <br /> Attach lour 141 c�pies of plans �or propo;ed work� �rav�tc scale ard noie ihe lollo•Ning as 2ppliCab�e: �-�_ � � <br /> Y Property Lines • Centerline of street <br /> • C�utline and dimensions ol all exis�ing and • Indicate 4nrth �A. i� � <br /> L' <br /> uropesed struc�ures on Ihe Int • ;,how any proposed grading changes L <br /> • Exi,ting and propused util�ties • Show measurements � �� <br /> .� � <br /> DO NOT WRITE BELOW THIS LIN� � � <br /> PERMIT CONDITIONS � '�. <br /> t.All calls for inspection shall be made 24 hr�.in advance-phone 259•8810. � �� <br /> 2.All work shall be peformed in accordance with ihis permit and current Clly of Everatt Design and Construction <br /> Standards and Specif�cations. �. <br /> 3.Call Location Unde�gro�md Serv�ce 48 r.is. before you dig.TOLL FREE NUMBER 1-800-424•555E � ' <br /> � <br /> � <br /> � <br /> �� � _ <br /> �� I' �7 <br /> ��I <br /> 11`}� — ACKNGWLEDGEMENTOi CONDITIONS �� ' � <br /> ���l, Tl�e undersigned owner/applicant he�ebl'agrees to hold and save harm- � <br /> less tt e Cdy of cvere�l :•om any and all claims fcr ,iamages, costa ' ' <br /> �� expenses, oi causes of ac1 . � h:.t may arise becaw,e of installstion ; <br /> �_�� '� �� � and maintenance ot �he ino�c.�ment or Mher righbN�way use heieto <br /> � ��' (�l'.� �F)• '�Ci•��{ ' �..,� <br /> appGcd for antl furiher ag:ves t_ remove same upcn noticz Irom Ihe <br /> Approved for ConsV ction Uate City and �o replace public proparry�amaged thareby. li <br /> (�� � i <br /> .�"-�c-�'Ci`_' ��-��U , Yv "� �. � <br /> �7��' �,;� <br /> FINAL WSPECTIOt� Date � - - � ( ���L�.Q.,� i��,;i <br /> A�.��qroved as Cor�structed Siynature of Ap"pGcant � � D/ a�� I <br /> everect PUBLICWORKSDEPARTMENT uWORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 18a DAYS OF DATE PERMIT IS ISSUED AND THEaEAFTER IS TO <br /> Everett,WA98207 BE DILIGENTLY PURSUEC TO COMPLETION. THIS P[RMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. I I <br /> � <br /> ..� <br /> i i <br />--. _.__. __---__ _ _. __. _. . ` � � I <br />