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C� <br /> � i <br /> I % <br /> i i <br /> � {W . � <br /> � � <br /> �.il:,.�;.j: > . .. �, � <br /> _ %'" � - � . �I <br /> j.:: iI <br />� � I I <br /> �L <br /> .� i �A.l <br />� ��- -� s�� - � � ,� <br /> Date � Public Wo�ks P•nn�l o <br /> � �� Application Fo. nm�� o�ai.. � �, <br /> PU ��IC �1,/ORK� RERMIT �b°�k°F�° � -- � <br /> iotal Fee � <br /> Less AppL Fce Paitl S " <br /> 1 <br /> Print or Type Only 6alanceDue s ��%�'G <br /> r � ��. �r��� 11 ,��� L)� ��1� ��(��b�� I�`.[I :L J '���^�� <br /> Owner Mailing�dre�s City Zip Phone <br /> Jr.t n � r i — <br /> Applicant Mailin�Address Gty Zip Phone . <br /> y� 1 /c�{- !� / � �� -;r—�/�7 r- 1 �/ <br /> Describe Prpposed Work __ie'��/� I C 11 �`J L-C�� �-"�'� �`' �+��-� _ <br /> I <br /> _ � <br /> I <br /> // j� .�) - �e <br /> Prolect Address(if known) �S���- �� ��" � ��'5.�. ` <br /> i <br /> Atlach four(4) copies ol plans for proposed work- Draw to scale and note the following as applicable: �� <br /> v Property �ines • Cenlerline of street ♦� <br /> � Ouiiine and dimensions of all exis�in9 antl • Indicate Norih V d <br /> proposed siructurps on the lot • Show any proposed gradinc� changes <br /> C Existinq and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CGNDITIONS � <br /> t.All calls tor inspection shall bc made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertorme7f in accordance with this permit and current CiCy of EvereO Design and Constructian <br /> Standards and Specjfications. � <br /> 3.Ca:l Location Untlerground Service 48 hrs.befor,e you dig.TOLL FREF NUMBER 1-800•424•5555. � ',I <br /> �`,L'� GI-IAN131 . Inl 'THP DF f.VLUJAY GJ f f UJ`.:T r.E F1P�fiNl�T' � ', <br /> ``� Thlr F'UC�Li.C _LlOFif.E� INSF'LCTO}t _ � <br /> .. , USE I-IIL�LIC DI;AIpdAGF SYSTCM flS �fiOVLDEU F01 C,��'.1M8f �UT^-,. I <br /> 6. �hll' I_OT GRADE CHAidGE� MUST Ec. A;•r�r:o'J�D Bti' `fl IG: � ', <br /> F'ULLIC WOFiFiS INSF•1=f'TDR, <br /> 7. {':EFF C?TY Sl'RLLTS CL_EAhJ (�T- ALL_TIMES. � <br /> S,� TIVSTALI. WAIE'fi EOXEB TO GRADE AT THE Ltlll CiF ''f�P��;'�l?UC'-� 'i'1il � I <br /> 9. f1F11 � ''I1RE �� i VEl�Jf1�'; �^d cG Cqi•!F'LLTEL.I' C IJIiG l! [ L� I�IiL � I <br /> i)i;1 l n.(; i li i I I �I't�!. <br /> � <br /> ncr.;�o:����o�eti�ENro��con�iliords i <br /> _ _ _ _ _ _ _ _ The undersig�ned ownei/apphcan�here6y agrees to hold and 5ave hnrm- � <br /> less the Ciry of [verett from any and all claims lor damac�es, costs, <br /> � expenses, or causes ol action thal may arise because of installation <br /> i <br /> ..,J �� T`_,_, i � ,n and maiMenance of Ihe improvement or elher right-of-way usE hereto <br /> . � � ' /y ?/�/�`' applied lor ana further agrees lo remove same upon notice Irom ihe <br /> Approved lor,ConstruC;ion � �e Ci a�d to replace public properiy damaged ihereby. <br /> �� �'.� �j7 / ��.- Lc'J��'i�"Gd <br /> � S �/ ' n <br /> vr . � Je,. i� � 1 . 5727/i�d <br /> FI AL INSP�� Date �Z! , <br /> Approved as �;onstructed SignLture of Applicant Date � <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMff IS ISSUED ,�ND THEHEAFT61; IS TO <br /> � 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. Tf11S pERMtT MAY BE <br /> Everett.l7A 98207 (.ANCELLEG BY THE CIT1'UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-F.810 FF�JEGT OVEH 90 DAYS DURATION. <br /> II <br />