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_ _ . � <br /> Date�L�L�i� ����oiicWo�ksPormn> �O =�Q ' <br /> Application For ❑10tj o"�° � ��_— <br /> i�flBLIC \IVORKS PERMIT PubLcWorhsFce � I <br /> ,o���F�� s— — <br /> I Less Appl.Fce Pai� S i <br /> Print or Type Oniy a�"�Ceo�� 5 2�_ I <br /> �'�I� `���22i n-I _G � �=�-'�7 L�L 5���'�'Y7� 9.��.�� �I <br /> Otivner Mailing Address City Zip Phone �. <br /> _��' �� -a�2.5 <br /> Applicant Mailinc�Address City Zip Phone . <br /> Describe Proposed Work j��_ � X \ 1 � �L�V / �A(�, <br /> ��� I <br /> p �7 f7J/ � <br /> Prolect Address(if kno�vn) ��/�/ -' f�— ��� �/= � <br /> Attach four(4) coGies ol plar.s for proposed•.vork- Draw lo scate and note ihe following as applicable: �p <br /> • Property Lines • Centerline of sireet /� <br /> • Outline and dimensions of ali existinc� and • Indicate North �� <br /> proposed shuctures on�he lot • Show any proposed gradiny changes <br /> • Existing and proposed utilities o Snow measurements � <br /> DO NOT WRITE BELOW THIS l INE � <br /> PERMIT CONDITIONS <br />� t.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this pe�mit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dic�.TOLL FREE NUMBER 1-800•424•5555. � �. <br /> ; .r1iVY Cf I!?i�lGl_ I PI -I-;iL DP:I VEbJl1`f CUT 11Uf;1 ?+E AF';;?OVFD � <br /> L�1' fI1E FUF+I_.ID Wf)hl :-� Tt�I:;FF�; �OR. <br /> '� ,U,E �'UBI_IC UFiATNACiF_ :iYSlE.l1 AS F'fi0Vfi1F.D F�1F I.i(11411'. �'OI.II '; ., <br /> 11tdY L17T rRA1JE CHAhdGE:� MUST BE FlFPF:O'.'�-D E:;' l FiL � <br /> i'UBI_IC Wf]�;ft:S :[IVSF'ECl"Of::. <br /> . I .EFf-' C1T`i STRFFI :: CLFF-lP! (1T (1LL "f f.IIf.S. 'A <br /> , �N`�TAI I.. W(�7ER C+OX�=C TO GF�(lUE AT TI IL I_:IdG 'JI �;pji;' i I•J i T:I OIJ \/� <br /> '- t•i�1P:E SURE nRIVEbJAYS FlRE C011F'LEl"ELY C:URl-1:• RrFnRE � <br /> I'�;! I�IJNG 0��! I'I-IF_NI. <br /> i_;, . �I !,� ll(1�1(d I . l"0 fl {E CiiF}: ;t�dD �'TitE?:I;�t`I I l�1rLi }i� �'F'f (i7rJ 1 � <br /> � r; I�I�IP: , I 7<_;I r', I i �_,i:! �,r rl.i�:_ , ��,I !.i i �nl _. , .I"�T <br /> i1CKNOl'JLGDGLF,tE.NT O�CODJDRIONS <br /> ��;_ _ llie u.�dersigned owner/aPPh�,ant hcicU%:9rees to hold and save hann- <br /> less ihe City of Everell iroin any and all claims for damayes, cosls. <br /> r j J expenses, or causes of action that may arise because of installalion <br /> c ����� 7/9O/p8 and maintenance ol the im�rovement or other right-of-way use herelo <br /> `� "�'� / C O applied for and further ayrees to remove same upon noti,e from Ihe <br /> Apomved rn Construc ion Date City and to replace public properq� damaged thereby. <br /> / � <br /> �� / • /C <br /> �� . ../��,�-- .l i n/�/� � �/��, '��/J� , g ��/�� <br /> FIhIAL INSPECTI�J�a r T—� Date -�1�"h � ✓ lJ-e-�G�iJz-� <br /> Approved as Constructed Si�nature ol App icant Date <br /> �vrrrt[ PUBLIC WOfiKS DEPARTMENT i WORK AUTHORIZED BY THIS PflRM1T MUST BE STARTED WITHIN <br /> � 3200Ced�rStreet 180 DAYS OF DATF PERh11T IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA99207 BE DILIGENTL� PURSUED TO CUtAPLETION. THIS PERMIT MAY 6[ <br /> Piione:259-BE110 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> I PROJEGT OVEfi 90 DAYS DURATION. <br />