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� � <br /> H <br /> t" y � , ,, <br /> � �H �-- -� -----.--------- ' — - --- - — ::- , <br /> k � <br /> �x� I l 19-9n ,-�" ,". <br /> H,d Date ,/ a�onc wo,xs c�,mn. <br /> y y A emq Oeata 9� 2�0�)�� I <br /> pplication For � <br /> o� PUBLIC WORKS PERMIt PuniicwmhsFee <br /> (�y Tolal Fee S <br /> � '� Z Le55/OPI.Fee Paia $ I <br /> v I <br /> Q� n � 8alan[eDUP $ I <br /> {••� Print or Type Only <br /> �H� ga�i � <br /> g�H i ��a��� �.�'-��.-}a�m 12�2o��r�hrrPe� n v !1 �l�'.��113� <br /> n y I Owner MaJin9 Address Cny Zip Phone <br /> ��� �l �� � �nv��}� �5�?a� -///� �ve /1)f �jir�;'lc�r�� 9X033 Q��i �;�� <br /> N � Applicant � Mailing Address City Zip '�{pRe�^� <br /> � DescribeProposedWoik �� �� — yfn�-�[J .S r � <br /> i <br /> I <br /> IPro;ect Address lil knownl � [l / ����7� /_�(�/ /�/ � <br /> � <br /> Attach four(4)copies ol plans br proposed wod;� Graw to scale and note ihe lollowing as applicablr: � <br /> • ('wperty Lines • Centerline of sireet � <br /> • Ontline and dimensions ol all existing and • Indicate Norih <br /> i proposed siructures on the lol • Show any proposed grading changes . <br /> • Existing and proposeA utilities • Rhow measurements � <br /> " � DO NOT WRITE BELOW THIS LINE <br /> I�' PERMIT CONDITIONS O <br /> I 1.All calis for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> '�' f 2.All work shall be pertormed in acwrdance with ihis permit and current City of Everett Design and Consiruction <br /> � Standards and Specilica�ions. � <br /> ' ' 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00-424•5555. � <br /> � <br /> � �'-�� G£Jcv��t�-ni.c-�/G�f.� /�RG-f/�-Gr�i7 � <br /> �- ����r.� �- <br /> 1'1 <br /> i�_..�9�� � � <br /> 0 <br /> `_; a <br /> ►-� <br /> 1 f ACKNOVJLEDGEMENT OF CONDITIONS <br /> � The undersi ned owner;applican�hereb <br /> ` __ I 9 y ac�rees to hold and save harm� <br /> � less the City of Eve�ett Irom any and all claims for dama9es, costs, <br /> � : expenses, or r.auses ol action that may arise because ol installation I <br /> and mdintenance of ihe improvement or other righPobway use herelo <br /> I' applied lor and lurthcr agrees to remove same upon notice irom the <br /> 4 Approved br Conslruction Date Cit <br /> y and to replace puolic property damayed Ihereby. <br /> I <br /> � FINdL INSPECTION Date . I <br /> IApproved as Constructed Signature of Applicant Date <br /> I everett PI�BLIC WORKS DEPARTIdENT WORK AUTHGRIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUF.D ANG THEREAFTER IS TO <br /> j � Everett,WA9820t BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT PdAY BE <br /> � Phone:259�881^• CANCELLED BY THE CITY UPON ANY STUPPAGE OF WOFiK ON THIS <br /> � NROJECT OVER 90 DAYS DURATION. <br /> ' � <br /> � __ _ _—.__ __ .________— <br />