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�_ <br /> � <br /> �--�� pn ��n�,�wo,k,P�, ; � <br /> Daley�— r � <br /> oiaq.oeo�.• , <br /> Applicalion For <br /> PUBLIC WORKS PERMIT PWbcWarksieo <br /> �r� .o,.�F�� s— <br /> � less AOP��Fcc Pai] S <br /> 9 H e.,i,�«o�E S <br /> ��H Print or Type Only <br /> aym <br /> " �� !� �'y,S)� Jy�� � �7I� �S�OI t��r�a���'1? Gt-aU �iJ��9k� <br /> � y%U Owner Mailing Address —(,����Y `. Z�P Phone i . <br /> � H K�y ��J</ `�'�� <br /> �� � <br /> � 0� AFPlican� Mailing Address City Zip Phone I <br /> HCi /� � , i I I I � . � <br /> ��gDescri6e Proposed Work _ r`' /� c' �y � <br /> n Y � •� � �����1 "l1�� ,l _ — �� <br /> H i <br /> z � <br /> � Hy W ' <br /> �' S J �,l �.�./� � <br /> H � <br /> n d y Prolect Address lil known) _ - , I ' <br /> � �" � ' ` <br /> z H N A��ach four(4)copies ot plans for proposed work- Draw to scale an note Ihe lollowing as applicable. � <br /> • Properry Lines • Centedine ol street <br /> y �N � putline and dimensions of all existing and • Indicate Norih <br /> proposed strudures on ihe lot • Show any proposed grading changes t <br /> • Existin9 and proposed utilities • Show measurements � � <br /> DO NOT Wfl1T[BELOW THIS LINE O � <br /> I <br /> � PERMIT CONDITIONS � � <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•881 O. �\ � I� <br /> 2.All work shall 6r,pedormed in accordance with ihis permit and current City ot Everett Design cnd Conshuclion r : <br /> '�'� Standards and Specilicalions. <br /> !� 3.Call�oc�tion Under9round Service 46 hrs.before you dig.TOLL FREE NUMBER 1•SOO•42d•5555. � � j <br /> i <br /> � 1 <br /> o�� I I <br /> �� '1'-2>=I-'�C_I C� vc�2-L=S -l��i�l �1 ��. � <br /> ��� �j"--ZZ —� /A <br /> V♦ <br /> �r�...-.SZ. �"��- O <br /> �.� a <br /> . <br /> o r y�i <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ` The uodersigned owner/applicant hereby agrees to hold and save harm- <br /> � ' ( less the Ciry of Everett Irom any and all claims lor damages. costs, <br /> ezpenses, or causes of action tha� may anse because ol ins�allation <br /> and maintenance ot the improverient or olher righl-o4way use hereto <br /> _ applieC for and lurther agrees to remove same upon notice Irom Ihe <br /> Appraved!or Construction Date Cily and to replace public pmperty dama�ed thereby. <br /> fINAL INSPECTION Date Dale <br /> Approved as Constructed Signalore ol Apn�icant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN I <br /> evemlt PUBLIC WORKS DEPARTMEN7 180 DAYS OF DATE PERMIT IS ISSU`_'D AND THEREAFTER IS 70 I <br /> � 3200CedarS�ree1 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV B[ <br /> EveieR,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURA710N. I <br /> I <br />