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,—_... . - , �- _ _ i <br /> I4ti_'�: <br /> I I <br />��..�:, . I I <br /> I <br /> I <br /> .�,�....1� <br /> / "�D <br /> �atQ /,'C�� PubllctVo�ksPer ' a /=����i �� ! <br /> % <br /> i,t-i�, <br /> Application For eme.o�v��>— � c_r�z_� <br /> PUBLIC lIVORKS F�� RMeI, Pu�licWorksF,a � <br /> Tolal Fca $ I <br /> li <br /> less�pCl r�C Pnitf 5 -'� � <br /> Print or Type Only e��,�_��o�a S �- � <br /> __�; ..��', � <br /> � �/- �3=�� i I <br /> � �x�t <br />� ��� : '�er P.lailing Address City Zip Phona I ' <br /> �-_ ��"�� I <br /> Applicant Mailing AdCress City Zip Phone I ��, <br /> ������ �I i <br /> D=scribe Proposed Worl: . ' <br /> i <br /> — — — I <br /> — T--- - — � � �. <br /> i� ��� � '/f� , � ,. <br /> Pro;ect Address(if known) "— - v _ i�' —' �J' — G�'- S_.E. <br /> ,itl=r'�..four(4) copies of plans tor proposed work- Draw tn scale and note the lollowing as applicable: w� ' <br /> • Property Lines • Centerline of street � ��. � <br /> a Outline and dimensions of all existin�and o Indicate North . <br /> proposed structures on the lot • Show any proposed grading chaogee�� ' <br /> i:� Existing and propcsed utilities • Show medsurements � <br /> ��aav�a•�. <br /> DO NOT WHITE BELOW THIS LINE <br /> PERMIT CC'IJDITIUNS � <br /> t. F�I calls(u�i�spection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> z 4:I work shall be per(ormed in accordance with ihis permit and current City o! Ever�it Desi9n and Cons�ructiun i <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig 70LL FREE NUM9ER 1•800•424-55.�5. ` ... <br /> j� �'�jr i<�= C��sTi,cil� ,�,��i�C=i•✓9 vfE�?tcGS'Sion/ �rlG1 � <br /> ,�`�l'o�r/s';.2v�T ��iT</ ,�"�<< f/���' �e%c'is'� Ge�- �;-e�� � <br /> ;���,r �'i f/ Si,a�v�?9�� � �'n-s �` �° �n� <br /> ,'i,� LC:I/.�T/-'-�-'l-j �1i`EGcJ ,c.'�.t�ib'E�rl.d� f E:t� Ci%�� STiiil.�p,A.E�.!' � <br /> 7JL77 � <br /> � <br /> � <br /> ACKNOWi_EDGEfv1ENT O�CONDI110N5 <br /> Thc undarsiyned owner/applicant her�by agrees to holU�nd save har;n� <br /> -- — — less ihe City ol Everett trom any and all ciaims for damages, cosis, <br /> � n �J expenses, or causes of action ih,at may arise because of installa�ion <br /> ����{�C� _ !S� � �j y�/ and main�enance of ihe improvement or other right-of-way use hereto <br /> , ��� L� � S`� applied for and further a9rees to remove sam2 upon notice from ihe <br /> Approved lor Constr ction Date City a�.id lo replace public property damaged thereby. / <br /> ���� Z� �� ��� � � 7 <br /> "INAL INSP[CTION Date �� �'' �-�� ' L���ru�� � ������ <br /> hpproved as Constructed Sfgnature ol ApPlicant � ate <br /> (everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Stree( 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> I � Everett, WA 96201 BE DILIGFN'!LY PURSUED TO COMPLETION. THI� PERMIT MAY B[ <br /> Phone: 2�9-f3£�15 CANCELLED BY I 11E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 D�YS UURATION. <br />