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Date `�/ B`/ o„„���w�,.t��,m��. _ _.— <br /> Application For N�av oco� • .—___ ._.__ <br /> PUBLIC WORKS PERMIT P������,�,�sF�e --- <br /> r��.�.oe s <br /> lessAna� Fe�•PaiU S <br /> Print or Type Only oa�a��eo�� s _ <br /> �.A. h�. C."��'/� o� 73/ /�d���('i�L Affit �'�> 9�aa� �S�- �/79 <br /> Owoer Madmg Atltlress Gty Lp Phone <br /> ��/� �3;%�'�Pu�t .���i Ff�����d� �v _5�zai �sa-ir?9 <br /> Apphtant Mailmg Atldress City Lp Phone <br /> Descnbe ProposeC Work � L / t 4 (.L_ Q / .� y�1/J � <br /> L' �5 " // S �� (.lJ _ -/ U/n�" <br /> � ^ '�— � _ � .. — <br /> // //�HJ/5 � � � <br /> , . , W <br /> Prolect Address(il known) � � C!/t/[ f/ / ��13�T�/1�f�%�/ � <br /> Attach four�4�copies of plans lor proposed work- Draw to scale and note the following�s applicable: � <br /> • Property Lines • Cenlerline ol street � <br /> • Outline and dimensions ol all existing entl O Indicale North <br /> proposed siructures on the lot • Show any proposed rrading changes <br /> • Existinq and proposed utililies • Show measuremen�s � <br /> DO NOT WRITE BELOW THIS LINE <br /> � PERMIT CONDITIONS O <br /> � 7.All calls for inspection shall be made 24 hrs.in advance-phone 259-8870. � <br /> � 2.All work shall be peAormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards end Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ` � <br /> E r�, O <br /> � ,�/��l�Jl�v /�FZ TI2�f{i G ��!�.i <br /> � <br /> r � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned oa�ner/applicant hereby agrees lo hold antl save harm� <br /> less Ihe Gty of Everett Irom 2ny and all claims lor damaqes, cosis. <br /> expenses, o� causes ol actlon that may arise because ul installatlon <br /> and maintenance ol �hc improvement or other right-ol�way use hereto <br /> applietl lor antl Wrihei agrees to remove same upon notice Irom the <br /> Approved lor Construction Date City and to replace pubhc pronerty damaged there6y. <br /> �'7 <br />