|
� � �
<br /> m �x
<br /> q H
<br /> 9Hti
<br /> r
<br /> �azi�-+
<br /> r� c�
<br /> � H � r - _ ,..� . ,-
<br /> � � / � 5`''�'-/S--
<br /> H Date � /�r: .�' n„ni���:�o�w,v����,�i„ � `'��� �� —
<br /> � z i � ei�a oco�.• �"�" ��TP.-�l- �J:���
<br /> y d Application For / —_
<br /> H � g i�UBLi�C WORKS PERMIT PuLToIaIFecFC1 S -
<br /> H� O ��sennoivecNa�aS�—
<br /> � �3� Print or Type Only o��,�«o�,,. s �-��-__
<br /> HH
<br /> g �'
<br /> �,
<br /> � C " �� I�.� n_ �� : ;! _ ('�11;,, .�' .� ��_ f_'�ara�_ ��i z� ; ?5 �' - �/>S'.
<br /> Cs7 � Owner Mailingl�afmss Ciry 7ip Phone
<br />� yom (` u 7/ 3 � G— ��/PiPYflNail l,/n./ �53-(aSDP)
<br /> -C.��:��:-l�:
<br />' Appliwnt I+lailing Addre=s G�y �P Phone
<br />' GescribeProposed'.Voik �ytLxl�lLi! �r��d10 p1 � c" n'py,p h"`' (�(� Qr�) {�S
<br /> �l
<br /> �
<br /> �'`��/c) � �Ci�iiL)ti' . S.� �
<br /> Project Adtlress(if known) _ � /
<br /> Attach four(4)copies ol plans(or proposed work- Drew to sr,ale and note the following as applicable: ��
<br />� • Properry Lines • Centerline of street ♦^
<br />� • Outiine and dimensions of all eaisting and • Indicate Uorih V�
<br /> propesed sVuctures on the lot • Show any propOsed grading changes
<br />'�� '�1 • Exisling and proPosed utilities • Show measurements �
<br /> i ' � DO NOT WRITE BELOW THIS LINE �
<br /> I` y
<br />� PEFlMIT CONDITIONS
<br /> 0�1 1.A!I calls for inspectio�shall be made 24 hrs.in advance-phone 259•8810. �
<br /> 2.All woik shall be pedormed in accordance with this permit and currcnt Ciry of Everett Design and Consiruction
<br /> � ' Standards and Specifications.
<br /> � 3.Call Location Underground Service 4B hrs.b2lore you dig.TOLL FREE NUMBER 1-800-424•5555. �
<br /> � 4 � > , ,�r ,� ,- �_
<br /> �i'_=�a„_ v,.,�-_��ay �- s� .� _._ , .> ,,,,,>E-,;,-; �
<br /> ��, �� _ � , , � ,�__� ,;,,, ,
<br /> T.'s-- :� i„-,. �_,',)._i-� �%,v,;r_, �i_ ,
<br /> v� �
<br /> 1- (� +
<br /> � I
<br /> �� �
<br /> 0-j � �
<br /> _
<br /> f � ACKNOWLEDGEMENTGFCONUITIGNS �
<br /> The undersigned owner/applicant hereby a7rees to hold and save harm�
<br /> — Iess the City ol Everett irom any and alt claims for damages. costs, �
<br /> expenses, or causes ol actlor, Ihat may arise because of installation
<br /> ,_1�� ri� ����� �.��� and maintenance ot the improvement or other ric�hbof�way use hereto
<br /> J �/ `�/�y�
<br /> applied lor and lurlher agrees to remove same upon notice from the
<br /> Apprwed for Consiruclion � Dale City and�o replace public p�operty damageA 'hereby.
<br /> �/ ��_ 6%6�,r ��._ � �% ; �� -;,� - x;-
<br /> FINAL INSPECTI " Date � � � /--��'- ' , '"' � �
<br /> qpproveA as Constructetl Signature of Applicant �� /� Date
<br /> WOflK AUTHORI�Ep BY THIS PERMIT MUST BE ST.4RTED WIiHIN
<br /> eveiett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO
<br /> � 3200 Cedar Streel BE DILIGENTIY PURSUED TO COMPLETION '.HIS P[RMIT MAY �E
<br /> [verett,WA 9820t CANCELLED BY THE GTV UPON ANY STOPPAGE OF VJORK ON TI IIS
<br /> � Phonc�.25&E1910 pROJECT OVER 90 DAYS DURATION. ,
<br />
|