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—r . � `T <br />�� _ �� � <br /> '� <br /> r <br /> '1 <br /> r <br /> 1 <br /> ���,]�J�3 P�pLf Watks Perm11• <br /> �3 /.�3 <br /> DateS'�."7" emo c�,oi..� /-• <br /> Application For _ <br /> PUBLIC WORKS PERMIT Fubli:WorksFea s_ao �� <br /> To�el Fee <br /> .� O� <br /> Leea AOG�.Fee PeiC S i� <br /> r �3alance Oun S-- � �— e� <br /> Print or Type Only �33�� i <br /> /� ' q ` S <br /> 1 �+�� G.�7 a� d v� ,¢����%e�. /���one �'��8 <br /> � Ciry <br /> Owner Mailing Address <br /> ! [ !c l! <br /> � u City ZiP Phone <br /> Applicant Mailing A� ress n <br /> � w c � e'"'- � �i1 <br /> � ."s . <br /> : -scrioe Proposed Work ` <br /> 6� . —t� --'-- � <br /> Pro�ect Address(if known) V 1 � `� �-yre SeE r ____ <br /> �� <br /> Attach four(4)copies of pl�ns lor propocad work- Dra�o to scale and no,e the following as app��cab!e: �1 <br /> • Property Lir.es • Centerline of streel + <br /> • Indical= Norih <br /> • Outline and dimensions uf all er.isting and � Show arY V�oposed�rad�n�changes <br /> proposed structures on the�ot � Show mtasuremen'� � <br /> • Existing and proposeo utilities <br /> r��� O <br /> DO NOT VVRITE BELOW Tf115 LINE <br /> PERMIT�:ONDITIONS ^ <br /> 1. All caiu for inspec:ion shall be made 2» hra in ativance- phone 259•881 5. <br /> 2. All work shall be pertormed in accordanr,e with this permit and current City ot Everett Design and Consl�uction � <br /> Standards and Specitications. � <br /> ° C�'I Location Undcrgr�un.f Service 4B hrs. 6efore you dig.TOLL FREE NUMBER 1•S00•424-555 . <br /> l/ '`�� ex�s��..` dr ..�e�...a� nPro.. -�,r 1^4� a lZ �s ,c~ �`C , � <br /> 1 f 1 1 � 1 <br /> O�* fl. �O.�fwS� • �t OebDUSfaI� �.tt ��0.n 7�o�..0 b 0. Pf�VlWw� <br /> 1 1 DSed/ 9�� �[�r� lI <br /> o» .1.t.c ay � ��:,.� �..,4Qy�. ,. zF � P� P <br /> 61sf �1. w;�� ka�..�� �- � <br /> ax.Q '1�� ol�. dr.�e.....�`�\ 0./f�,.�.. c� 1 I . ,/�/ � <br /> � fGW�W� tW PwwY ['�I��-P�Y yu�'FY� �N\I nQ1,N/� GNrIf A�nSG O <br /> 1 C �.J ,� �.F E„cn�rt <br /> .A,�aI' S��[ww�L. � �[f TGG'��o.. 3.3.7 0� L/x <br /> reS � <br /> Q.do1w wo.-k.� 51-.�..�a..Qs. C.o.��n.v�- �e P..b1i.. v.iu��s Z�+.fec i � <br /> �pi �.OH�!\' kL�'G•\ Q�.�0.•\� C��el� � �L�S�AH�.r�� lJ'4 �1wY <br /> GN,NN �� S.de,....�k w.,�k. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> I The undersigned owner/applicant hereby a9rees to hold and save harT- <br /> less ihe City of Everett Irom any and all claims for damages, cost.:, <br /> expenses, or causes of ar"=" �ha� inay arise because of installation <br /> / �p_b j and maintenance ot ihe improvement or �ther righl•of•way use hereto <br />� �" � applied for antl further a]`ees to remove same upon notice trom the <br /> ved for Const ction Date City and to replace public proUerty damag:d thereby. <br /> �' � �Iz, i�� <br /> L .6.. � • . 7/a 83 J <br /> FINAL INS ECTION \ Date D e <br /> Sip Wre ot ApP�icant <br />' Approved asC�nstructed HK AUTHOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />' everet[ PUBLIC WOR'(S DEPARTMENT 180 DAYS OF Ci;TE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> O 320J Cedar Street BE DILIGEN7LY PURaUED 70 COMPLETION.THIS PERAIIT MAY BE <br /> Everett,WA 98201 CANCELIFU BY THE CITY UPGN ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•9815 PROJECT OVER 90 DAYS DUR�TION. ' Q <br /> V <br /> �.. <br /> J <br />