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__ � I <br />; <br /> f : . � <br />�;: i <br />�` ; i� <br /> �!/�7�e�'��—�^ s L�- 3�s III <br /> Date 11—_—' U✓ Pubhc Works Pnrmit a _ C/ I <br /> AppCwlionFor em�.ocu�.+ �� - I <br /> P�16LIC ��7RKS PEI�MIT P�°���W��.,F�� g — '� <br /> To�al Fee <br /> Less Fo���Fee Pald S_ .l <br /> Balance�ue $ ��l�� '�'. <br /> Print or Type Only � <br /> ��'_��`� �''l'� �C'z'r)?�7<``,�-�Y_�1.��,t� �'�=�`�s i I <br /> , <br /> Uwner Mailiny Address C�ty ip Phone ' li <br /> _ _�.��. -�3a � I <br /> ApplicaM Mailinq Address City °ip Phone I � <br /> DesCribe PrCposed Work 71— K ( �1� �� 1 15��.�,� ��t `I� <br /> /� p — � <br /> Project Addre�s(i( knovm) �L�O OL�� �� ' � ���" : � <br /> Atlach tour 14) copies ol plans for propose:l work- Draw to scale and note the following as applicable: o <br /> • Property Line� ! Cent2rlin= ol sireet ♦A <br /> • Ouiline and dimensions of all existing and O Indicate Ilorih �� <br /> proposed strucW�es or�the lot • Show any proposed yrading changes <br /> I • Exisiing and propesrd utili�ies • Show me�isuremer+ts � � <br /> DO NOT'rVRI7E BELOW THIS LINE ,�\ <br /> PERMITCONDITIONS A�/ � <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 25£•881 D. � <br /> 2.All work shall be performed in �xordance with this permit and cunenl Cify�f Everett De=_ign and Conalructicn � <br /> Standards and Spe.^.ifications. <br /> 3.Call Location Undergro�nd Service 48 hr5.be(ore you tlig TOLL FREE NU NBER 1•800•424-5555. � � <br /> �l .�IIUY (;f I(II��GE. .UV l'FiF Uh[VF"WAY CUl !`11.1 � 1 I:C '1� I f�U'J�:[` <br /> Pl' II�F F'l1Yt_.If] {JORI;S ZI�I� FEC. fOF�. � <br /> i.I1SC �'UEL'!C n�:n.rninn� S`(S1'f.;t'I (1S ^fiOV!UI'f! ', U04JPIF�'OIJfS . <br /> S.(1NY LC1T Gi:ADE CHF-1Nf�E� P1U5T E�[� AF'F'F��'JEI? + I �;I_: � <br /> ^UIItL II: 4J0f;1:=, 7P,IRF'ECI Ofi, <br /> , I':CFF' C]:"f'i STREE'(S CLEF114 A"f �LL 'fIP'IEE7. !� <br /> ; , rNST(11_I_ 4JATFFi E�O;<ES TQ GRf1UE AT TI-Ik= riJ1"` I:71 f;01�l:il"ftllf' i-?�i�a V� <br /> ?, Pi(�1F'E ELIF:G l:)R7l!EI�J(11'� ARE. Cl]tiF'LFTELY CUF��:=D '�.;:! ORF- � <br /> 6RIVThd6 Cl� TNEf9. <br /> iu. (-lh,!Y nn�9AGE TO TF-IE CIJFE, AIJD SI:DEW('iLl: WILL EtF FEF'ftIRFD � <br /> l'0 iilE S,'1TT;F�C"fI01V 0� TI��:. F'UFLIC I�IOFP;fi DEF'1'. <br /> �� �'O7ri�e ..f°-ei _/Le��u���Lltfvue .�0�-... ��,e0i c� Lv3'� do >roi/u�Ly. <br /> /�/.J d�v�.,,�....�, cn� S � ai . (/ <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and s2ve harm- <br /> �� � -- less ihe �ity of Everett from any and all claims for dama�es, costs. <br /> ��>°Y / eePenses, or causes ot action that may arise because of installa�ion <br /> /y��� �/,=sp ,�.�/�/�,� / and maintenance of lhe improvemen� or other right-of�way use herelo <br /> l�-- ' ���' (�x"�_ �� cS�e applied lor and tur�he� agrees lo remove same upon noticr frum ihe <br /> pproA ved for Gi nstruction Date City and to replace public pioperty d2maged thereby <br /> FINAL INSPECTION Date � �'*�"` ��� <br /> Approved as Consiructed SignaWre of Appl canl Da�e <br /> evere[t PUBLICWORKSDEPARTMENT WORK AUTHOHIZC-D BY THIS PERMIT �4UST �E 6T�iR1'ED WITHIN <br /> 180 DAYS OF DATF PERMIT IS ISSUED AND THCREAI'TER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMP�E710N. THIS PFRMIT MAY BE <br /> Everett,WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:i59-8810 PROJECT OV[R 90 DAYS DURATION. <br />