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I <br /> I <br /> / p� <br /> � LIGC!—.S�', <br /> Date , / Public Works PRgiji•; <br /> b�—� �'�l '7C <br /> ' ApplicatianFor eia�.o�oi.a / (� //(�Z��__ <br /> � <br /> �� �1 i� ����� �� yr� 1� ('ublicWorisFe_ <br /> L 1 � l i Totai Fee 3 <br /> Less A0o4 Fca Paii $ _ . <br /> 7 lC <br /> Dalancc Oue 5 G U— <br /> Print or 'fype Only <br /> ,� J:z � �' �� �`�/- ���� <br /> �' wner ( Mailiny Address Cit, Zip Phone <br /> t <br /> - ���n� = — -- — — <br /> Applicant t�4ailir.g qddresr.� City Zip Phone <br /> - Describe Proposed WorY. <br /> �/ �� <br /> �� <br /> Prolect Address(it knownl ��C.� y(`� G��? -_���h G�.<-� S� _ � <br /> � � <br /> Attacn four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: �� <br /> • Property Lines • Centerline of sireet �� <br /> s Outline and dimensions cf all ezisting and e Indicate Vorth t��, <br /> proposed structures on �he lof O Show arry proposed grading changes <br /> • Existing and proposed utilities O Show mi,asurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All c.,:ls for inspection shall be msde 24 hrs. in advance- phone 259•881 5. � <br /> 2. All r,ork shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Localion Underground Sr.rvice 48 hrs. before you dig.TOLL FREE NU�iBER 1-R00-424-5555. � <br /> t� ,<�f�c•rC/E cx;STii'JG- ,�,C'ii%'-uJf,y ,lL=.�i'Ess.cil/ q•vn � <br /> ��COA/�.C�UL'% L�/T/�f FCiLL �E/GNi CiJ.�G' �' �>C;'i7El=% <br /> ;��",� ci�y -ST�.c1.,�.��.5 � .�as � �3oc�. � <br /> � !�i♦ <br /> _<.-- �"cUuS.—,E'uGi �tJf�v' C�c� -�L�,.��'� /c;_ l�j� <br /> � i/'�.(.Z��i�� �-�O� � <br /> � <br /> .�UKNOWLGDGEMENT OF CONDITIONS <br /> The undersu�ned oc:ner/applicaN hereby agrees to hoid ard save harm- <br /> Iess ihe City of Lverelt irom any and all claims for dam;ge;, costs, <br /> � � � expensec, or causes of action ihat may arise becausa of installation <br /> � ���� ���J�✓ ���'�� and maintenance ol the improvement or olher right-of-way use hereto <br /> applied for and furthcr agrees lo remove same upon noiice from the <br /> Approved for Con ction 7ate �ity and to replace public property damaged ihereby. <br /> FINAL INSPECTI N ` ✓� �� � . '/L��/% .�/'I l�-:J ��/ J�(�_ <br /> Approved as Consiructed igiia ure ot Applicant/ / Da,c <br /> rverett PUBLIC WORKS DEPARTMENT WORI< AUTHORIZ[D BY THIS PERtv11T MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS ;p <br /> Evere!t, WA 98201 Bc DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 25�-86t 5 �.•NCELLED 6Y THE CITY UF'ON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DH a DUF;ATION <br />