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______ _ _.. _ <br />, � <br />� � i <br />', � �. <br /> .� <br /> �; <br /> �E;, <br />� i�n <br /> i <br /> i <br /> �I <br /> (/ /�� � p I <br /> Date_LtLL_ PubhcWorFSFcrmpo — �L-LLL`Y'z � i ' <br />� Application For emg.o�o� •� , , <br /> P!;Bl�IC WORKS PE�iMIT � � <br /> Publ¢Wprks Fee <br /> Total Fee S � <br /> Lass 4ppl.Fac Paltl S � �i <br /> Print or Type nnly e��,�«o�� S . 2doo i �,I <br /> � '� 2�11—_ �o�� � r, �� �� r-�ai� �5�9 ,� I� <br /> Gwner Mailing Address City Zip Phone I <br /> Applicant Mailiny Pddress City Zip Phone <br /> De�cribe Proposed Work __��� L-lJ � '� / �,�� '�"�,� <br /> Pro�ect Address(if knov:n) �� 7Z� — /!���.P SE � <br /> Att�ch four(4)copies ot plans for proposed work- Draw to scale and noie the following as applicahle: � <br /> E Property Lines • Centzrline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> p:oposed;Iructures on Ihe lot • Shov.�any proposed yradinc� chanqes <br /> • Existing ar:d proposed utili�ies o Show measuremenis � <br /> era <br /> DO NOT +�RITE BELOW THIS LWC- <br /> PERIdITCC:JLITIOYS � , <br /> 1.All calls foi i�:.,pection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Everetl Design and Construclion <br /> Slandards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � ' <br /> %E , fliQY Ct IfII�IC�F I t� I f l I)R I VCt+!('i1' C'l.� i i°I(l�T i.�E (1F'F'FOVFT� � ' <br /> L+`( TFiC PUBI_iC UOR'r.:S Ihl i�CCTOF. <br /> S, I��E FURI rC I�R/11�J(16F �1'E' fFl•1 AS F'FC11�71�FD �OR Iif1V11��F011f'i1: <br /> 6.�1NY LOT 13R(1DF CH(11�IGES I`11J�1' E+L AF'F'ii�'!,'1=1i I:;r I I�I : � <br /> F'UBL.SC 4�JORf;� Ir�ISF'LGTGfi. <br /> 7.1'CEP CIT`( STREET.� CLE(-1N !1't (1LL 'T:R11 �, . �/\ <br /> 8. JNL�Tl1LL VJA7FF� BO�ES TD GF�I)G r1'f l'I 'i_ i=1�u) f11 f'(li�P; i �<�J�.'. f�Il7i=f �/♦ <br /> 9,M/1}:::E ;9URE DFtIVFlJAYS AFiF_ C011F'1_FTEI._`i CIJF;f1:L'� Is� i'IIIU: � <br /> DRIVING ON THEhi. <br /> i0.l�ll•.IY DAh7,1l�F_ TO Tt-IE i1URB Flr�in :,rnr-idn�t wr�...� rL: Fii � �� if"tf:D � <br /> l-0 THE �(�TISFAf:I"IOt�i p(' TI-IG FL1BL_IC !JORI;; D[:F'"I- . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hotd and save harnr <br /> less the City of Everett (rom any and all claims for damages, costs. <br /> expenses, or causes ol action ihal may ari;e because of installation <br /> � � / and maintenance ol Ihe improvement or other rigM-obviay use hereto <br /> , ��'�� "'" �� applied for and furiher a�rees to remove same upon notice irom the <br /> Approved lo Construct on ale <br /> / � City and lo replace public property damaged Ihereby. <br /> ! �j/�"�f��� <br /> �" _e ���'<<������� A' � .�I� � <br /> FINAL INSPECTION Date � <br /> Approved as Constructed ature of Applicant D te <br /> everett FUBIIC WORKS DEPARTMENT ONK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � J200Ceda�Street 1U0 DAYS OF DATE PERMIT IS ISSUED '.ND THENEAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETIUN. THIS PERMIT MAY B[ <br /> Phonc:259-88�0 CANCEL.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> ���� <br />