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h <br />� <br /> S� � S" .Q��-//D <br /> Cate ' Publlc WoihSPmmi1• - ` q <br /> Bltlg.Depl.+ � L L <br /> Application For <br /> PU�LI� W(7RKS PERMIT PubTotalFceFee S <br /> Less AOP�Fce PaiE $ <br /> +J � ? <br /> Balanc9Due rJ � L�� G� <br /> Print or Type Only '��6,�� <br /> � �, � � � � <br /> Owner Mailing Address City Zip Phone <br /> . . . . ., . . . . . . . , < . _ _ � � , . �— `p <br /> ApplicaN Mailing Address _ . City. . . ,Zip� . . �J Phone �� <br /> .. i . _ . , . ;, ; . . C� <br /> , _ _ rn <br /> � .. <br /> Describe Proposed Work � � ' � � � � '� � � � ` - '�t" ' � <br /> .-� .. <br /> —I Ti <br /> — H .-i <br /> VI S <br /> __ m <br /> � o <br /> co <br /> mc <br /> — , _ ._ �, - - _ . . - - � � � <br /> � -'r� .�. • -. � ' � _' . -i c <br /> Project Address(it known) '�� � ' ' -- — � m <br /> Attach tour(4)copies of pl�ns lor proposed work- Draw�o scale and note the lollowln�as applicable�. ia� _ -� <br /> 6 Property Lines � Centerline ot stree; � m �+ <br /> O Outline and dimeneions of all existin�and e Indicate North '� L <br /> proposed s:ructures on ihe lut • Show any proposed grading changes n � <br /> • Exisiing and proposed utilities • Show measuremenls r � <br /> � -� v, <br /> ee+�� �eeuma -� <br /> DO NGT WRITE BELOW THIS LWE � <br /> -�n a <br /> PERM!";COIJDITIGNS -I r+i <br /> 1. All calls lor inspeclion shall be maCa 24 hrs. in advance- phone 2:i9•8815. _ <br /> m .-� <br /> 7.. All �xorl<shall be performed in accordance with this Uermit and current Gity of Evcrett Desyn ard Cons�ruciron o � <br /> Standards e.nd SFecilicatiors. o r <br /> 3. CaII �_ocaiion Underground Sr.rvice 48 hrs. before yeu dig.TOLL FREE NUMBER 1•S00•424-SCi55. � c N <br /> 3 v� <br /> m <br /> '/ /�GiCdi✓% .SHdLL +C'E�j'G<rL zc� <br /> Ti slf� t"� f�/'� /��M.4�.c D � m <br /> SiGFC�IAL,� Cf'EG TEL� DU�iivi� i,y� �c9N_C7!c-�iiG� � . A <br /> J����CC_s�, ��c•Z�c'G��G«.<'_' r{�L'c NOic; .G�EL�:' � -' <br /> S' <br /> ,�il/�? �f����i._'O.��iL' ) � -- <br /> / <br /> � v. <br /> z <br /> � � <br /> rt <br /> aa <br /> ACKIJOWLEDGFMENT Of CONDITI�JNS <br /> The undersionnd owner/applicant hereby a9rees to hold and save harm� <br /> less the City of Evereu from any and all claims hr damar�es, cos�s, <br /> ' expenses, or causes o( action thal may ari,e because of installation <br /> �- // /1� � and maintanance of the improvement or other right-ohway use herelo <br /> �:�✓' '•'�?L�-� �� ��`r applied for znd further a�rere �o remove same up�n nolice from Ihe <br /> Approved for Construr,tion a�e Cily ano to replace public property damaged there6y. <br /> � � � � �-��� ��� � � <br /> FINAL IN PECTION Dat �/a�2/�'� <br /> Approved as Consi:uct\d Sign ture ol Applic N' Date <br /> PUBLIC VJDH S D�PABT ENT ���aRK AUTHORIL D BY THIS F RMIT MUST BE STARTED WITHIN <br /> everett 780 DAYS OF DATE PEHMIT IS ISSUED PND ThIEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGF.NTL'! PURSUED TO COMPLETION. THIS PERM1IIT MAY BE <br /> Everet�,WA 98201 GANCELLED T�'1'HE CIT'I 7PON ANY STOPFAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJFGT OVER 90 DAYS UURATI�W. <br /> � <br />