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C�1 Cy+J � <br />Axlx <br />q H <br />9Htn <br />1 !}! <br />yi� <br />� � � <br />�y0 <br />CA H <br />H <br />z <br />�HG <br />� L�1 c� <br />Hy � <br />ry� <br />H �J <br />�y <br />C] Ct7 � <br />td <br />�H� <br />HOcn <br />� v.4 <br />Da�B%-� 7-� � " <br />�'. <br />Pl1BLICG <br />t _r <br />� <br />Pr+nt er Type Or�ly.: <br />,�; <br />[�I <br />� ._ �4 . _ ..�J <br />Describe Propased Work <br />Project Address (il known) <br />Application For <br />W�JRF�S PERMI� <br />t'i <br />r� <br />�o <br />,',T T� .�G <br />�_ T Mailing <br />�n <br />o ¢ <br />_'`' "31 l� 1 <br />Mailing <br />�lk <br />n�ei��vm�xsre�m�n. �� !t'3. <br />BICp. Oept • <br />Pu�LCWorksiao $ <br />Taial Foo <br />lesx FpLt Fee PaN $ -- <br />8ainnceDuo S ''}'�� � <br />l�l�'-3c'Z- 5'.�-Ov0 - //-�8 �/ <br />Zip <br />Zip <br />Attach iour (4) copies of plans for proposed work - Drew lo scale and note the following as app�icable: <br />t Property Lines • Centerline of street <br />! Cutline and dimensions ot alt existing and • Indica�e Norih <br />prqposeA structures on the lol • Show any praposed gradin9 changes <br />• Existing and Froposed utililies • Show measurements <br />L �J-I - = 1 1 � <br />Phone <br />25 ��- 7 1 1� <br />Phone <br />n� C I l' Y <br />�� ' <br />IVlC� �. � � <br />. � <br />�A <br />Y i <br />FERMIT CONDITIUNS <br />1. All calls lor inspeclion shall be made 24 hrs. in advance � phone 259•8810. <br />2. Ali work shell te pedormed in accordance with this permit and current Ciry ot Everett Design and Construction <br />Sl�ndards and Specilications. <br />3. Call Location Underyround Servic2 40 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />y s,�����,� <��-t � � � ,�r��<<<a� r,; . ������ <<���� ���4 i��. <br />, � <br />.Lc, . �kC.. �!� � �L�r �C ti�-.:., . ll/cc9if v �tc, C�7tc4�c�'r. � .(� �lc(.^i �n. .,_� <br />�� ��t�t • <br />� ��-tl'�� ������ch«z ��� „� «� dlw <<-z��x�� �� �,< </ � � <br />' S NL�n . <br />/ , <br />o�' )�i��� Ccti,2ctc<'�.%i ��kL.L�-. <br />�,/ PUBLiCWORKSDEPARTMENT <br />� 3200 Cedar Sheet <br />�� [veretl.WA98201 <br />Phona 259�8810 <br />�/ <br />� S <br />,v <br />. � , / S <br />J <br />� <br />/liJ�� , ' /"�� ACKNOWLEDGEMEMTOFCONDITIONS <br />l � The undersigned owner/applicant hereby agrees fo hold antl save harm� <br />less lhe Ci�y ol Everet� Irom any and all claims lor damages, co;ls, <br />enpenses, or causes of action that may arise because of installation <br />�+ s%, and maiNenance ot the improvement or oiher righFol-•Nay use hereto <br />applied for and lurther agrees to remove same upon notice ��om thc <br />��e City and to replace public p�� rty domaged there6y. <br />i <br />�7 <br />��G -� ����--� ��/' / � � n I`I I <br />ate � <br />- j Sig re ol AGPlicant •� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIThIIN <br />180 DAYS OF D.1TE PERMIT IS ISSllED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV 6E <br />CANCELLED B'/ THE CITY UPON A�': STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />