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/ , <br /> .! i1 � �F <br /> Date��7 Pu�iic Woiks Pcinid• <br /> ame oeo�.: 3 �.�--r�/� <br /> Application For _ <br /> IPU�LIC 1Al��iKS PERIUiIT R�D�icWoeksFee �.�, . � � <br /> Tolal Foo $ <br /> Less Appl.Foe Pnid � <br /> 9alencc�ue $ ���� <br /> Print or Type Only 3 Y7,2t371 <br /> n.� � �(-�,7=� -yV��L�I.�� ��/iV/L/(.Cil")C�. �7/i"1� 7'`������%�5 <br />. �/-1-l�sst.C��: ���t.liC� <br /> Owner Mailing Address C ty Lp Phone <br />� � � C- JN UTJIG�Li f/-t.�/� ��I� �Z�L� z <br /> I�k ,�.iD���o,.� 17�c�9 ��f'-/IV(� I� 24 B <br /> Applicant Mailing rlddress City Zip Phone � <br /> n <br /> m <br /> Describe Proposed Work � �v���"� r ^ `�'`�U�L rA��L J pwLL1-�tiLT� <br /> � .. <br /> I � T' <br /> � � <br /> __ vi �: <br /> �� m <br /> 0 <br /> cc <br /> mo <br /> I U�OZ � )*� ���� C� L-, _ � -a c <br />' Pwject!�.ddress(if known) � s <br /> � m <br /> i Allach iour(4) c,.pies of plans for proposed work- Draw to scale and note the following as applicable: �� _ � <br />� • prouerty Line,�, o Centerline of street �'^ <br /> 8 Indicate North ` .o z <br /> O Outlina anA dimei�sions oF all existing and O Show any proposed gradir.y changes � <br />� pwposed structures on the lot � D � <br /> i Existing and p�oposed utilities e Stiow measuremenis � _ <br />�I =i in <br />. � DO NOT WRITE BELOW�fH15 LINE � K <br /> PERMIT CONDITIONS ._.i i <br />' 1. All c2l:s�er inspec�ion shall be made 24 hrs. in advance- phone L59•88�5 x <br /> 2. All work shall be pzrforr,ied in accortlance wilh this permit and wrrent City of =��erett Design and Ccrstructlon � m N <br />� Standar a and SpeciCcations. � <br />, 3. Call Lucation Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•4?4•5�.`i5. � �n <br /> c v: <br /> � :�. 3 �n <br /> 1 (\ \ II m <br /> E%IJ�LN` C.A� �I G� �n✓ `1��Qwll� �:..C.!(:"-�'i � `lti.l:l-CI.`.� Lt l�� a lt � "'� r <br /> 1 <br /> �) 1 1 m <br /> N�. �o.wct-`r^ Jc c✓t" �\_� "t-�...-.r � D <br /> I _ � - . .-o <br /> i � --� <br />� s. �lzb{,s ��s �,��- �,��.� �. � ._ ....� , , _. <br /> , ri�. �� , , : �-� �.� . - <br />� rr,.,-.,�.,tc� -Y�'� �..._ l��t+�� � -- <br /> I , ' � � <br /> ��� -.,��� ��A� 1�2N�1'llJ`� G���fL(.�� � l:���t:�� - �t_ / � � <br /> '�1 <br /> ND /�rf.)SLti��; I- �_� I <br /> � � <br />� �j�g�i� i s �� f�E S — zScx� - �s-{ � �-s�- e <br /> L��._ �� -�.�,1.�_ ���� � ACKNOWLEDu�TOFCONDITIONS <br /> f �;1 (I �, (�j �4'l"he undersigned owner/appliaant hereby a9rees to hold and save harm- <br /> �w' less tne City of Everett from any and all claims Icr damages, costs, <br /> �.__ expenses, or causes of acticn that may �rise because of installation <br /> 1 � � C�� and maintenance of the impr�vement or other right-of-way use hereto <br /> � �� �-/ �� applied for and turther agrees to remove sama upon nolice from the <br /> � Approved lor Construction Date City and�t�rpblace public property dart ageA thereby. <br /> ,_� 4 � �t <br /> �C:���.y� f� lL�' 7 I4� � ��e�' ' .1 , � ` <br /> FINAL 'NSPECTION � a�e � r �ate <br /> Approved as ConstructeJ � � Signature ot Applicant <br /> WORK AUTFIORIZED BY THIS PEFM1IIT MUST BE TARTED W�THIN <br /> everett PUBLIC WORKS DEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED ANG THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Gverett,WA�J0207 CANCELLED BY THE CITY UPON AVY STOPPAGE OF WORK CN THIS <br /> Phon�� 259-BB15 PROJFi,T OVEFl 6u^ DAYS DURATION. <br /> 1. _ . . _- _� — <br />