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_ _ . �� <br /> :� <br /> , <br /> , ,:.., <br /> Date �; 1�'7 ���i � . � v„o���wo�kzP�,r,��. �_ � <br /> � eino oeoi,.�i' < �- <br /> '. Application For <br /> � <br /> PUBLIC WORKS PEH14'd �T °°°;ow,��eF�e S — <br /> y("�H �oss noo�.Fee Pam 5 , <br /> �ir� � <br /> � BaianreUuc S <br /> ��� Print or Type Only . <br /> r: <br /> aHt�'i� ' � , � �i Ill�;. �Ul� <br /> .� .� ,� .1i �< <.�: i � � I <br /> y 'z r�i ' �L; l! ��i;r n) �` {E f-�'--t � .i�1.�1 -„r-�r<--� /,:._'?.� �/5i- l'iy%1 <br /> �C O � Owner Madmg Add ess Gry Zip Phone <br /> H xl <br /> O x0 I ."i . � _ <br /> i >:•;""' I �u , .�:i:J • 7.-;�� <br /> � c~nH ' /i� i�l« n. fl� vlt �i + I ; 1` C / '� �-U� Y`("t7' ' <br /> yx z� Applicant Maihng Ntldress Gty Zip Phone '. <br /> t�7 y� ��'I _ � , (.' : • / ' �� <br /> O H �� Descr;be Proposetl Work y ... /�-r�/' i i l 7( -7'f,) 1�'�/lf�`� ;� � .'z�–� '�. <br /> ttl C]t7 'i ��, <br /> '-- <br /> �h��-^ '� ;)��;i�� /r r �'t �/r!'�!�� — ���� <br /> tiH3' I <br /> > Ht� ' , A <br /> y <br /> t H y � fF1d <br /> � �� , Prolect Atldress(d known) � L(��( C- �J��i��[��1) 1 r !�_ -- � I'! <br /> !7 �� Attach lour 14)co�ies o� plans br proposed work� Draw to scalc and notc ihe lollowing as applicaUle: � I � <br /> Zy N , • Property Lines • Centerline of sireei /�� �� <br /> y p� � � Outlino and tlimensions ol all existin�antl • Indir,ate North V� <br /> � proposetl strnc�ures on�he loi • Sho�v any proposed�rading changes I <br /> • Exi;img and p�oposed Wililies • Show mCasuremenlS /�/q � <br /> _ _ .. . ._ �1�� II <br /> � DO NOi VJ�.ITE BELObJ TNIS LINL o <br /> ' PERM!l CONDITION3 ; <br /> � 1.Ali ra��.�or inspection shall he made 24 hr:.,in advance-phone 259•881 O. ■�� <br /> 2.All wo.rt shall be pedom�ed in aCCoidance++ilh Ihis permit and a.ureM City of[vcrelt Design and Cons�ruc�ion ♦ 'i <br /> �'�"�' Standards and Specilications. <br /> ' I 3.Call Location Undergrour�d Service 48 hrs.before yod dig TOLL FREE NUMBER 1•SOO•424•5555. � �I <br /> �� � ' <br /> �� � I <br /> � f._ . � . ! "� I <br /> � ��,. ; : . . __ . . � , <br /> ; <br /> @s _ � w <br /> �� I . . � .. �/ ' I� <br /> g/ I <br /> 7 .s <br /> � I <br /> •�.�m.� � I <br /> �<_.. ,� <br /> .�.;i i i <br /> �CKNO�"JLEDG[MEN�(OF CONDITIONS I <br /> � �"' �� The unde�signad mvnedapplicant hereby agrees to holtl anA snve hnrm� j <br /> �,� less ihe Ci�y of Everelt Irom any and all claims lor dama9es, cosis. ii <br /> expenses. or causes ol action �hal rnay anse because of inslallalion <br /> I and maintenance of the improvement or othe� ri9h4oi-way usc hereto ' <br /> applied lor and Wriher agrecs lo remove same upon notice Irom �he <br /> � Approved tor Consiruclion ��« G�y and to rep�ace publir.property d.ma9ed iherehy. II <br /> �i I <br /> ' — Date I <br /> � FINAL INSPECTION p��t <br /> ' Appro�ed as Constructed I Siynaturc ol Applicanl I <br /> ! WORK AULHGRIZED BY THIS PERbtiT MUST BE STARTED WITHIN I <br /> '�i rverelt PUBLICWORKSDEPFRTMENT 180 DAYS OF DATE PERMIT IS ISSUF.D AND THEREAFTER IS TO I <br /> � 3200CedarStreet BE DILIr-�,�T�Y PURSU[D TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 9tl201 CANC6LlED 81'THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> Phone:259�AB10 pRO.,ECT OVF_R 30 DAYS DURATION. � <br /> _.... __ ___ _ . ..._ . ._. <br /> . . . .___... .._._.__. . ___. _ _ -__._____ _._.._.__ ' <br /> �. .. .___._.._ .. __.._.._. . ._ . . . .. - _ <br />