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i <br /> �,.:.:, Date_(�� y ✓ <br /> Fubi¢Wo�FS Permil� _y� / —" G�,,��. <br /> � h / �7c/�� p <br /> !.Y`j Applicatien For eiap oco��• �Z!—¢q��J— <br /> i � <br /> '' ` PUBLIC WORKS PER�IIIT P°°��°W°��s°Ce -------- <br /> Toialpee '—_-- <br /> ��] , Lassfppl.FeePaiO $ _ <br /> L�� <br /> '� Print or Type Only e.,�����o�� S�— _ <br /> =�: • <br /> ;";. Cn� la�{O6J�']IIILIIe'L S�PPcIG/Qrr LVd ,�/rxc0�BP�� 3S.�.3/� <br /> ''� � Ow er , Mailing Address City Zip Phon= <br /> �s�' S° ",� — <br /> r : � Applicant Mailing Address Cily Zip Phc���e <br /> �?:i <br /> � p A�e��sln�/e �r �Tr�—:r�/P� L /p� �_�1h 111L.�D��_ <br /> � <br /> DescribeProosedWork � �IV �l CP - LD/ O Pd/ !Jl !'!' 7 <br /> i;" <br /> �,� , . <br /> � - --� W <br /> � _r_,� � <br /> . Project Adtlress(if known) 5�y� � -� ��`e=���f. _. <br /> " Attach tour(4) copies ot plans for proposed work- Draw to scale and oote the tollowing as applicatr � <br /> • Property Lines • Cenierline ot sireel � <br /> • Outline and dimensions of all existing and • Indicate North <br /> � proposed siructures on the lot • Show any proposed graAing changes <br /> � Existing and proposed uflities • Show measuremeMs � <br /> DO NOT WRITE BELOW THIS LINE <br /> � PEflMITCONDITIONS O <br /> ' 1.All calls for inspection shall be made 24 hrs.in advanre-phone 259-$810. � <br /> 2.All work shall be pe�formed in accordance with this permil and current Ciry of Everett Design and Consiruction <br /> Standards and Specifications. <br /> - 3.Cal!Location Undergrourtd Service<::hrs.before you diy.TOLL FREE NUfABEA 1•500-424-5555. � <br /> .�� � » C�ONui <br /> : � lin�2 ��.-���c.�ti� �.r('/Ct% n=�lR.`isr<<< .fllt.r�C- .O/Jri�./ .11.Ci � <br /> O � �� �c <br /> �rn, �ilc.� ,(c� ' C✓?2ena•t,t' �ie-�7' /1C �C'Ff�ccCre��l �e�ce✓� <br /> i4 • . � � <br /> C✓c �l�cz-��� ��..,,.. �� O�-c�c--rr� / ..lo�z:7is,�.�' a7` Z%�e.� � <br /> �CI-T` �7trz,�i�i 2cc.i• � <br /> � �/�C7.r�>� ���C"/LG�,AC�4.<n7 .r .lJ/�<r_�� /J/f�.�/ 2('/:i-i/�-�/ <br /> Cd��NY /7l���^Ci L..(/t��'-�. U.��h�},Cb'/o-(" q�T� '�?c:c27� O <br /> � G_�•C� � <br /> fE .�.�.� G� <« „z���z . a <br /> ACKNOWLEDGEMENT O�CONDITIONS <br /> The under5igned ownedapplican�hereby ai.,�.�,.;to hold and save h,um- <br /> � less the City of Everett irom any and all cia��.ms lor damages. custs. <br /> �J expenses, or causes ol action Ihat may :,rise ';ecaus� of installation <br /> �'� �� � ^+/�/��J and maintenance ot ihe improvement or other right-of-way use hereto <br /> '� ��� � � �/ applied for and further agrees to remove same upon iotice from the <br /> Approved for Cons uctio Date City and to replace public property damagc�d thereby. <br /> �n���-- 7-T-T'O -.. '� \ c <br /> FINALINSPECTION Date /�� � \ �� ` '� \�'e-���`� �I I� I ���— <br /> qpproved as Constructed Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT N'ORK AUTHORIZED BY THIS PERMIT MUST BE STA�TED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 720ilCedarStreet BE DILIGENTLY PURSUED TO COMPLETIGN. THIS PEP.MIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJEC7 OVER 90 DAYS DURATION. <br /> I <br /> I <br /> � <br /> I <br />