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i <br /> i <br /> H H � <br /> � � My ', <br /> H <br /> � yy _ , . � <br /> H �� <br /> ��O ��� i <br /> �� �, ��/'/y �l- 7 � <br /> y y Dete_I -� ' " ✓ / a�ni�cwo��.svu,m��j� ;z J <br /> o�� TO P0531NG� -�-9Z emno�o�-=C1—l—���5 <br /> AnPlication For �—�--�� <br /> ��g PUBLiC WC'RKS PERMIT F°°°°w°��=��° _ <br /> ,o�.,�F�� s- � <br /> �Nr � lesSPpnl FxePanf S____ � <br /> xy e,i�����o�o 5����---- <br /> � Print or Type Only <br /> Hy <br /> N <br /> �„� n � � /'• l <br /> ���' ( •-l.�l �ii"�� . � � ���� �j, � �,���7 ���'���i� � <br /> � Owner Mailing Atltlress Cily :_�p �Phone � <br /> y0[�i� � �� I <br /> � Applicant Mu�6ng Address City Zip Phone �� <br /> i <br /> Describe Proposed Work ����— _ — ' <br /> --'_ W � <br /> Proleci Atldres5lit known) 4�� z �_? 2'4�+ A�/� �---- — � <br /> A��aCh loUr(A) CopiBs 01 Plans foi prppOSP.d work- Draw Io 5cale and no�e '+e follo�•iny as applicuule: � � <br /> • Properry Lines • Centedine ol street /^ �� <br /> • Outline and dimensions of all existing antl • Indicate Norih V� � � <br /> proPosetl 5tructure5 on the lol �` Show any proposed gratling chanyes , <br /> '�t • Eris�ing and propo5ed u�ilities • Show measuremen!s � � <br /> ' ' � DO NOT WRITE BELOVJ THIS LINE O <br /> � <br /> '�� PERMIT CONDiTI)NS <br /> 1.All calls tor inspection shall b�made 2d lirs.in advance�phone 2S9•881 O. � <br /> 2.All work snall be peAormeA io accordance with this permit and current Ciry of Eve�etl Design and Construction <br /> 1�' Standards and Specitication;. <br /> 3.Call Lcc-'i;,��Underground S��rvice 48 hrs.before you dig.TOLL FREE NUMBt81•800-424•5855. q �, <br /> 1 L � <br /> � O ; <br /> '�1 � � <br /> �f , <br /> — � ' <br /> 1 � � � <br /> ►-� <br /> a <br /> �....� <br /> ACKNOW�EDGEMEHT OF CONDITIONS <br /> � � � The undersigneA owner/anP�icard Y.ere6y 3yr es to holtl and save harm� <br /> less the City ol Everett Irom any and all Gaims for f:.mages, costs. � <br /> expenses, or cnuses of actian tha! may arise because o' ��"allation � <br /> ;� r'/ `A/l�_ �� fcj. ;��n��� and maintenance of the improocment or uther rlghhoFwav �.wc here�o � <br /> _� b app��ed �or antl tur�hWr 3qree5 lo remOve Samz upon nG•'ce I�� m Ihe <br /> Approved for Com i Etion ���e Ctly and to replace eublic properry dama9ed thereby. � <br /> ���d-� '-/��-50 � p � ' %/'�/f� <br /> FINAL INSPECTION Daie � �� �'"'� �"" � <br /> Approved as Consiructed Signature oPApplicant � e <br /> 'NORK AUTriORIZEC BY THIS PEHMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g� DAYS OF DATE PERMIT IS I�SUED AND THEREAFTER IS TO <br /> � 3200 Cedar S�reet BE DILIGENI LY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everet6 K'A 99201 CPNCELLED BY THE CITY UPON ANY SiOPPAGE OF WORK ON THIS <br /> Poone:2E9�P.910 pROJECT OV[R 90 DAYS DURATION. <br />