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i <br /> � <br /> ( <br /> i <br /> Date ��._.1) C. n„ei.�w.,,w��n,m�i. �> �"T�� <br /> Applieation For mnu oeO� • <br /> PUB�IC WORKS PERMIT # <br /> [�i�l�if WOIAf�p! <br /> 101T1 11�� S <br /> lrss Rp01 f!!PTnI s <br /> Print or Type Only n.,�.,��«o�P s�_ <br /> �?�lil�l �' ��r�.i th �—P.xs.X �"�2 ( .�_ `�a.�.� C�53 -aC�`� <br /> Owner Malling Address C�ly Zip Phonu <br /> �rv�"_ <br /> --- - <br /> APPlicen� Madmy AAdress CdY Zip . . ..I��n�.,,. -. .. _.._ . . <br /> Deacribe P�oposed Work ���1—an�J'c�=J! I I�`: ._ . . . <br /> Prolect Adtlress�d knownl --1�U �� 9 f�St. S r-_ � <br /> Atlach lour(4)copies ot p"ns lor proposed work� Draw to scale anA note Ihr Iollnwing ns appliwble�, � <br /> • Pnperty L�nes • Cenlerline ol streel ♦A <br /> • Owlmr and dimensions ol all eKisl�ns anA • Indir.ale Norlh v� <br /> proPosed Slru�'tu�e5 on�he lot • Show any propoSeA pi,�dinq r.hanqes <br /> • EMisling nnd proposed utili�ies • Show measurrments � <br /> DO NUT WR�TE BELOW THIS LINE <br /> PERMIT CONOIilONS O <br /> 1.All calls lor inspection shall he mede 24 hrs. in xdvancn-phone 259•88�0. � <br /> 2.All work shell 6e peAormed in qccordance wilh ihis permit and currenl City ol Everett Design and Construction <br /> Standerds and Specilicaliuns. <br /> 3.Cel�Locellon Undeiground Service 48 hrs.beloie you dig.TOLL FRE� NUMBER 1•800•42d•5555. � <br /> 4 .r�il�l'� i;lir�l�d(��f.� ll�l lllf-.- GfiiVElJl1Y CU1� PIII`.il f�E i'ii-'FF���'��.P � <br /> 1"�Y TF�C� � �li}�tl. If�. I�711ltl� .. IN:7FELitJft. O <br /> ;i.USF_ fl!DI_IC' DF;f�INi=1C,f: 3YSTf_I1 AS F-FiOVIf11� f'� F�7R I���Ib11�P i �ill ��� ', . <br /> b.ANI' I_OT ..r(ADF C'HANfiEu I'IIJF'iT RE AFf'R(ll'i_I! I�\' 1111 <br /> F'Uf+LI� W�f�b � INi:PFf lOfi . � <br /> / I fFP Cl fY S1FfETS [1t EAN Af AI.L lTPIL'<. <br /> Ci 1NSTALL. WfalfFi POY,f, TO I9fil1DF (1T THf I"lil� �:I iJn�':;TF7ili'Tif1Pl ,w <br /> '? M(1rF &UFF DF1VfId/iY°, ARE C'(��•IPLFTFLY C'iil'�I I� i�F:F(�Fil V, <br /> DFIVINF, DN T1IE{M. O <br /> 10./-1NY� f1fiP1l�f�f' l�0 TI�1P CIIRH f11��1I-) RIDEld/ll_I; WTL.I_ E1E f<I f'filf<CI'� <br /> T�l .f�il. ,.Irl l"1`�I-i��'.-f i f Pd Of- THP f'I 1131 T i' bJ(ll'•�I �S (1Ff'T . � <br /> y <br /> �. I <br /> nGkNOWLC.DGEMfNT OF CONUITIONS ' <br /> Tne undersi9neA owne�iapphcanl heieUy ayrces to hold and save harm� <br /> - less Ihe City ol Everett Oom any and nll claims lor damages, costs, <br /> / /pp� expenses o� causes ol achon that map arise because ol installa�ion <br /> ��7( ,L�j�yw /✓ /• `;�� nnd mainlennnce ol Ihe improvement or olher nghDobwey use herelo ..� <br /> ���L. // �/L �F �pplieJ lor anA lurlher a9ree5 to remove same upon notice Irom the <br /> App�Oved lor GonSirucl cn Dnle Cqy gnd lo �eplacr, pul>hc property damaged �hereby <br /> �' — � � :i > ����,� � ���' �b� <br /> FINAL INSPECTION Da1e },�1 <br /> Approved as Constructed Sig�alwe ol ApPhr.ant �-- Date <br /> WORh AUTHORIZ[D EV THIS PERMIT MUST BE STAFTED WITHIN <br /> �ve�rrlt PUBLIC WORKSDEPARTMENT iB0 DAVS OF DATF PERMIT IS ISSUED AN� THEREAFTER IS TO <br /> � ;1200CetlnrSlreet BE DILIGENTLV PURSUED TO COMPLETION THIS PERMIT MAY BE <br /> Evrrrtt.WP.9B20t CANCELLEO BV THE CITV UPON ANV STOPPAGE OF WORH ON THIS <br /> Pnanc 254-BH10 PROJECT OVER 90 I�AVS DURATION <br /> � <br /> I <br /> � <br /> i <br />