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i ` l -, �,� <br /> Date /, l <,/ I Puhhc l5'orks Pcimit v _ ��� ��— <br /> CJ� �'1 l�Y1 <br /> Applicalion For em�.o�p�._ _y1_(� � �� <br /> �U �LIC WORKS PERMIT PubTololcFksFbe S -- <br /> Les.,ApO�Fec Faitl S ^ ` <br /> Balanc.�Ouc $ �C'� <br /> Print or Type Only <br /> ��'���1�aJ ' ) � ��'' �► � � �,�ui s-tt�nr.���-t��' q����� �,�-,3���= <br /> wner Pdading Addres� Ciry Zip Phone <br /> S�-V��1� ` <br /> Applicant ;d�iing Adarr,ss City Zip Phone � <br /> Describe Proposed N'ork ._ '��— <br /> --- W . <br /> /l' 7 — i0��'6zP_S6_ �'rJT�_; n�i-�<�t—,-�x, <br /> Proiect Address(if known) �' - H 1 <br /> Attach four(4) copies of plans for propused work• Draw to scale and mte the following as applicable: �� � <br /> • Property Lines . • Centerline of street �A . <br /> �1 Outline and Aimensions of all exis�in9 and • Indicate Norih r� ' <br /> proposed strucWres on the lot • Show any proposed grading changes <br /> • Eristing and proposed utilities • �how measurements � � <br /> ir GO NOT WRITE BELOW THIS LINE � O ; <br /> PERId17CONDITIONS ' <br /> 1. All cz•,s for inspection shall be made 24 hrs. in aCvance- phone 259•881 5. � � <br /> 2. All work shall be per(onned in accordance with this permit and current Ciry of�verell Design and Construction <br /> StandarAs and Specificalions. � <br /> 3. C�II Location Underaround Service 48 hrs. betore you dg. TOLL FREE NUMBER 1-800•424-5555. o� <br /> � ��:vE..�i%�c._ f/�s� c:z-n�,� ./" D.t�.�'cL<.ca� //�s f� C+auc�� � ( <br /> C /i-/IT. <br /> �,t,f/ �/='Ti,'Ei= D�,n��c f %l� T/�=�' S.'oL�.✓�G.0 $ � ? <br /> i�<.t.C,.���-y� SiYf:'lc ��E� .r'C=i�i'1.�='v d/ f)f�i�l�c�'ti!`^ � , <br /> � ; <br /> � ' <br /> ACKNOWLEDGEMENTOFCONDITIONS ; <br /> The undersigned owner/applicant hereby agrees to hold and save harm- � <br /> less the City of Everetl from any and all claims for damages, cosis, ' <br /> — / ' expenses, or causes of action ihat may arise because of installation I <br /> �' �.(!-�� � _,,-� ' / and maintenance of the improvement or other right-el-way use hereto � <br /> % J� s� /�� '-�T 1 ��� applied for and further 2grees to remove same upon notice from the <br /> Approved for Construcfi ��t Ciry and to replace puhlic prope�ry damaged thereby. <br /> - 3�`u�7 ,/ / �" <br /> 22 /(/ % — � L <br /> FINAL INSPECT N Datc L'-���� J��� � � —�'//� <br /> Approved as Constructed Signature of Applic it Date <br /> PUBLI(' WOFKS DEPARTMENT WORK AUThIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DAT�E PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY ?URSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF N'ORK ON THIS <br /> Phone' 259-A815 PROJECT OVER 90 DAYS DURATION. <br /> ���� <br />