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Date�l /. J � <br />ApPlication For <br />PUBLIC VVOFiKS <br />Print or Type Only <br />Describe Proposed Work <br />Proiect Address lif knownl <br />, i. <br />PERMIT <br />e2 <br />n <br />0 <br />� o c� <br />� O O <br />� �� <br />o r� r� <br />.. �,� w <br />Address <br />Attach lour (4) copies ol plans br proposed work - Draw to scale <br />• Property Lines <br />• Outline arA dimensions ol ail existing antl <br />proposed slructures on Ihe lot <br />• Exisling and proposed ulilities <br />/} ✓ <br />PubM1c Wa�ks PC��y�y--.{, ��I�" ' C��� <br />ein� oeo�. + �11-1-�-`� _--- <br />P�bhcWo�MSFea 5 <br />Toiai vice <br />lessApO� FnePaN S <br />3,� o" <br />o�i,��� o�� s <br />Lp <br />Ihe lollowing as appucauie� <br />• Centcrline ol street <br />• Indicate Norlh <br />! Show any proposed grading changes <br />• Show measurements <br />311�-1�33 <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with ihis permit and current City ol Everell Design and Construclion <br />Standards ard Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />Si jF l c/('/�%' S/iAl C CG'/+�PGJ/ L�JiT/� SK_FTC!/ �PP.�'�`VED <br />�.�I /�'�.?S-�� ! . �C'c,�� .��TA�i/,� D> <br />Approved as Construcled <br />everetl PUBLIC WORKS DEPARTMENT <br />I � 3200 Cedar Slreet <br />Everett, WA 90201 <br />Phone:259-8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F <br />�w <br />_ / <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to held and save harm- <br />less the City of Evere�l from any and all claims lor damages, cosis. <br />ex�enses, or causes of aclion ihat may arise because of installalion <br />snd maintenance of the improvement or other righl-o(-way use herelo <br />applied for and lurther agrees to remove same upon notice Irom lhe <br />Cily nd lo repla ubiic roperty damaged thereby. <br />ZS <br />Signature oi Applicant Date <br />WORK AUTHORIZED BY T IS PERMIT MUST 9E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEU AfvD THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLEI�ION. THIS PERMIT MAY BE <br />CANCELLED B'! THE CITY UPON ANY STO?PAGE OF WORK ON THIS <br />PROJECT O'JER 90 DAYS DURATION. <br />