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i <br /> � <br /> �,, , <br /> ; <br /> �Date �� // ''� PubbcYJo�ksFermitv �==_-G � <br /> Application For BICg Depl.s .___ <br /> PUBLIC WORKS PERMIT Put�licWorksFee <br /> Tolal Fee �-- <br /> Less ApPL Fee Peid S , <br /> PrintorTypeOnly TO POSTING_ '�' ri Balance0ue s _ <br /> `e� Cs/9,eG6=0 ' <br /> � _� o2r/ O-1H,�7t SirE� i <br /> /� � ��=.�'.ii I <br /> (��o� /Veriri/h l.S j%tc2.� / �7 �v� J'L; �d����� • <br /> Own r Mailing Address Ciry 7ip � Phone I <br /> ;�2uc E 337-3Si S� <br /> Applicant Mailing Address Cily Zip Phone <br /> / <br /> Describe Froposed Work S ,Y r✓' Yh��" _ �n ✓ /96 r�/�S�C/ <br /> _ ?hfi�n I <br /> / , <br /> Wj <br /> Prolect Address(it knovm) �! ��2J'— /9 y� �vc. ..�_ � i <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note Ine followinc�as zpplicable: � <br /> • Property Lines O Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes � <br /> • Ezisting and proposed utililies • Sliow measurements � <br /> DO NOT WRITE BELOW THIS LWE �I <br /> PERMIT CONDITIONS O <br /> i.All calls for inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be peAormed in acwrdance with this permit and currenl City ol Everett Design and Conslruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you Aig.TOLL FREE NUMBER 1-800-424-5555. � <br /> tl I,us.-,�cc_ T�i>c` ��' C.'9,-cy i�!J�Si.c� Prs,< ci7/ O <br /> �S'Tqn,'o%'�'D '��cc�'., .9,r�l� G"� .r.sJr/JdaE /n.->rEc°i.�L � <br /> �5'._=i�i/i2i1>o,c Pci� c�T� sr,l,✓Q/�•c°/>. �' s�io (/a17f�f y�D� <br /> �� Y/ <br /> lls� /o Di�, /�ii,d.i�r�i�� f?c.�C. S/��z -,�S Lc.� /'ci �� <br /> /• 6%�ili�. Cz95.ri�`%J; O <br /> �//B�BB — CAtLc[� c?�zt�c� 9rop Toto f/ii,-J yt' c✓ouGU �t/�c0 A <br /> �? a <br /> B-�f0 Am. /yj�„��mun, ,�F 3' aF Cov�.� ovF.; r,✓F /'v�. q.ua iF <br /> � <br /> H� CJ[/CONT (JcT /T /7E �yOGC/,� �/Sc= CaNC.E'Fr P/OE. ; <br /> /�E S9i0 f/E �S P/qNNi�G ON POv2ia/.'- 7NE' /�A�"��'✓G <br /> GpT lviTH 6 ��Of Cvi✓�n?E7r A�/O /-�Ou[O .'�(/T GUi2E/�/£Sf� � <br /> plF,e. ThE A.��9S e.� Ts,/c' DRF�n�/l�i� ACKNOWLEDGEMENT OF CONDITIONS <br /> /F f/E co�i�o ^�or �Er 3'o` Cov�.e <br /> r TntO �/�n 7»r CJOGt J dE O�he undersigned ownedapplicant hereby agrees to hold and save harm- <br /> — ' less the Ciry of Everett Irom any and all claime for damages, costs, <br /> expenses, or causes of action ihat may arise because of installation <br /> r �� /�/� � and main�enance of lhe improvement or oIh f righl-ol�way use herelo '. <br /> �����✓��-� ��J��� applied for and furiher agrees to rempve�s me upon notice Irom ihe - <br /> ApproveU ior Construcfion ate Ci�y and to repld Public propert�d�/nag' d lhereby. �� <br /> � ///��� <br /> / �-.� /// �/',/ /� <br /> � � r '��f� �' i� y�Z ,�/ ��n !/ <br /> �FIN� NSPECTION -T— D2te ��" /� " <br /> Aperoved as Constructed Signature ol Applic�nt Date <br /> WORK AUTHORIZED BY THIS PERMIT PAUST BE STARTED WITHIN <br /> everelt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CIT'I UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259��810 PROJECT OVER 90 DAYS D'Jf7ATION. <br /> � <br /> ��i <br /> I <br />