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� <br />��� <br />f� � r�i <br />C, H <br />9 H Cn <br />N �H <br />� H� <br />� H'�J <br />V1 H <br />Hx <br />t�f O <br />H C7 <br />H�g <br />�] Y �❑ <br />� H t+7 <br />HH <br />� <br />g❑e� <br />�1 � C+1 <br />H O fyi� <br />` ,? / /.Z S —Y- <br />Date� <br />Application For <br />PUBLIC V1/ORKS PERMIT <br />Print or Type Only <br />Owner <br />� <br />%/a�c� �j� � - <br />Mai{ing Address <br />�;�5—� <SGcJ <br />Ci�y ZiP <br />Pwl. NbnS Ve�m�l • - <br />e'�ao Oen�-+� �-f� —�:� <br />/ _ . ___. <br />PIILIi[ \YOfk4 FCO S <br />Toial Fec <br />Les9 P001. Fec PaiJ S <br />BalanCe �uo S <br />.;s- <br />Phone <br />App�i�����/�� Mailing Address City Zip Phone <br />Describe Proposed Work � '� � �� ��6 � �� <br />`7 � -7 - s_3 �cl <br />Project Addrr,ss (if knownl <br />Attach four 14) copies of plans lor pronosed worh � Draw to scale antl note the following as applicablc: <br />• PropertY Lines • Centerlinc �� street <br />• OuO�ne and dimenswns of ali exis�ing and • Indicate Nor�h <br />proposea structures on the lot • Snoei any proposed 9ratlin9 changes <br />• Er.isLn�j and proposed utilities • Show measuremenls <br />�� <br />PERMIT CONDITIONS <br />7, All calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. Ali work shall be pe�ormr.d in accordance �vith this permlt and current City ol Everett Oesiyn and Construction <br />Standards and SpecifiCal�ons. <br />3. Call Location Under9round Service 48 hrs. Lefore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� Jy ��O_.Ll�.�.�J /G�;/ �vi�(G(i.r,�tcO <br />� � �[��, �r7�.! <br />'��/J <br />5 c, r / <br />ApO�oved lor Gonsiruction <br />FI�AL INSPECTION Dale <br />ApUroved as Const�ucted <br />�� PU6LICWORKSOEPARTMENT <br />3200 Cedar S!reel <br />Evcrett. WA 9II201 <br />Phone�259�6U10 <br />W <br />L <br />�� <br />N <br />W ' <br />o ' <br />/ <br />� <br />O <br />� <br />Y � <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />1 hv uncfersiyned owneUapPlicanl hercby aprees lo hnld and save harm� <br />-- - I.:;cs �he Cily ot Everat� irom any and all claims lor dama�es, cosls. <br />expenses, or causes of action mai may arise bewuse ot installation <br />and mainir.nance of �he improvement or other ri9hFof-way use hereto <br />_ �pplieA for and lur�her a9recs to remove same upon notice Iwm �hc <br />Ciry :�nd lo ieplace Public propertl' dama{3eA �hernbY. <br />Si9natu�e ol Applicant Dato <br />WORIC AUTI�IORIZ�D BY TfiIS PEHMIT MUST BE STF.RTED WITHIN <br />lA0 CAYS OF DATE PERMIT IS ISSUED AND THFREAFTER IS TO <br />�[ DILIGENTLV PURSU[� TO COMPLETION. TFIIS PERMIT MAY BE <br />C0.NCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />