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� <br /> ��; � �-, <br /> Date� " -�� � v��,�,�wo�kzPo,m��> '"5a-� / <br /> c> - <br /> Application For ���s�oeP�.x <br /> � <br /> PllBLIC WORKS PEf�MIT P����`��0 5 9�`�O- <br /> Lvss Appl.Fce Paitl S <br /> Print or Type Only e,�,���o�� S ZO� <br /> �Z�_ �r�>f. a�aa �f:�� ��- � c����C�� 3�g-o�`;�� <br /> Owner Mailing Address City Zip phone <br /> -�.1-3tLL��� <br /> Applicznt Mailinc�Ac:dress City 2ip Phone <br /> Describe Proposed Work �1—� �,�n� V"1 ����I� ��i-uc�d <br /> Project Address(il known) �'09- /Or%c�7��s`_ � <br /> A!(ach four(4) copies of plans for proposed work- Draw lo scale and note the following as applic;bin: � <br /> • Property Lines • Centerline of�:reet � <br /> • Outline and dimensions of all existiny and O Indicate North <br /> proposed structures on the lo� s Sho�v any proposed greding changes <br /> • Existing and proposed utilities O Show measurements � <br /> DO NC'WRRE BELOV✓THIS LWE <br /> PERMIT CONDITIONS � <br /> 1.All callc for insGection shall be made 24 hrs.m advance-phone 259•8F31 Q � <br /> 2.All work shall be pertorm d in�ccordance with tt�is permi�and current C:i`y of Everett Desic�n and Construction <br /> Standards and Specifica�ons. <br /> 3.Call Localion Underground Service 48 hrs.hefore you dig.TOLL FREE NUNIBER 1•800•424-5555. � <br /> -=6,-AlU'Y' Cklril`lGL--, I.N .:t1:IL._DRI'JEWAY CUT f'iUSI I+E !t�FRpVELi � <br /> BY THG F'UH�.�:C-YJO�;Y:� IRISEEC"fOlt. - . ...__-_.__._ ___ <br /> U�E PUE�LIC DRAIrIA�E BYS'I"�I�t F1g FIiO��iD�Q �OFt DOWMSP�J�1 � <br /> , ANY LOT GRAD� CHA�II',GS NL�!S.-i 8G AG'F'F;LtLGD Et�'.. .TI-JE- . .._ _ - <br /> PUPI_TC WOF'F�:S I�IBf='ECTOf:. � <br /> �, I:EEF' CTTY_�1RL�"fS_CL.EAN. l�f;Fa�L- TSh3F:�.- . . <br /> ?I�I!'T�i L. t^1(�7Cf E;D/,1 � 7Q 6FI1D�_" F1T TFIE FPI� OF COhdSTGUr'f:fOh� � <br /> ', � I��r11:1 SI iR�'� DI .i �,E':� � ARE Cnttf`I..FTELY Ci.!REll BLF G��:1= <br /> � � . ,-,�,; ;_..�.� � <br /> i:f-; i .!t:i.,,I:' _. ' I_ _ <br /> ACf(NOWLEO�;Fhi�NT O�COhlUI�IIONS <br /> The undersgned owner/applicnni neieby agrecs lo hold and Save hornr <br /> ' �...s ihe City ol Everell Irom any ond all claims for damac�es, cosls <br /> � �. cxpunses, or causes ol action that may arise because o( installa�ion <br /> � '1 ., _ �- and main�enance of the improvement or other right-of-way use hereto <br /> App�ovetl for Construction� ---� �� � - <PPlied for and further agrees to remove same upon notice 'rom ihe <br /> , . ��'��Q Ci and to replace public property damaged thereby. <br /> ���c��_c� <br /> , <br /> FINAL INSPECTION p��c /�LG7 ��.�i��'Y�� 7`Zz/��� <br /> ApProved as Constructed Sign ture�o�Applican� �� Date <br /> [�vcrt�tl PUBLIC WORKS DEPARTM[NT WORK AUTHORIZED 8Y THIS PEHAiIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 8E Gill3ciV ILY PURSUED TO GOMPLETION. THIS PERMIT MAY �G <br /> Phone:259-8810 CAfJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DA`.'S DURATION. <br />