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I <br /> �te�C"� PUDLc Wcrly Parmil r eV_ • <br /> � ADDIiCation For eiee.oea�.r <br /> PUBLIC WORKS PERMIT P�°Ta„FeeFae = <br /> lesa ADO��Fee PeiC S�_ <br /> Print or Type Only eam��a o�s S Z� <br /> � ► � ,�}� �o �:��J � �'AvF �_ `�V��nrr1.(S,�l a�-�'�rJ <br /> Owner MaiHng AddreSs CAy Zip Phone <br /> �YI � <br /> Applicant Ma�hng Address City Zip Phone <br /> DescribeProposetlWork �`x �I �� ��`� � /vr <br /> (�T 2n (�u�r v� Pir'�'_ ��t�t <br /> , . <br /> W <br /> Pro18Ct Adtlress(�f known) Z3G�3 - m B � <br /> Attac�four(4)copies of plans for proposed work-Draw to scale and no[e the following as applicable: � <br /> • Property Lines • CeMerline of street � � <br /> • Ou?line antl tlimensions of all existing and • Indicate North <br /> pr�posed st�uctures on the tot • Show any proposed grading changes <br /> •Existing and proposed utilities • Shrnv measurements � <br /> � O NOT WRITE BELOW THIS L�NE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspectan shall be made 24 hrs.in adva.nce-phone 2S9•$810. , � <br /> 2.All work s�all be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> $18ndards end$peciHcatiOns <br /> 3.Call Location Undergrountl Service 48 hrs.be�ore you dig.TOLL FNEE NUMBER 1-800�42455$$. � <br /> 1� ANy Fiu To � �A�P aN TH�s [oT S.s�9c C B� �zv� O <br /> �$'o q5¢ TifE UN��O�M Bu:�o�aG <o� C��E.e 70. <br /> 5 q,�jl Fi[L .9cTivisf/ T�/�T WiGL /mA9�T �"�E A�^�"/i�✓/r H <br /> Lors s�c c f.e.rr B€ �o.eov,�o �y 7i�` ci� � <br /> Pv.3 e�c' �./o,e,ts v€PT, <br /> (p, /UO OBST.2UGTio�V �/�IX'�t�.esLS R�9�✓7ER� 7.P.&E.f'� Fjl�C�. ��) O <br /> S'N.9c c gE Z>✓sr�7CCEo ACo�/G TiYE' 1��ST S�tlE OF TyE � <br /> D,QivEuJAf/�ru7�e.v.1/eE Ts/fIT tLbueD AP�'verri✓T A /I�OTo2itT COAVA//r <br /> DUT OF 7H� l�Piv,fs�/Af/ F.ea����"nqq g�pS'6ai.✓G T A�c C��NG f.e0in T.�E' <br /> w/_-'s'T oN A�.�ms ST. ���y�&� ACKNOWLEDGEMENT OF CONDITIONS <br /> T�e undersigneA owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for tlamages, costa <br /> � expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other rigM-of-way use heret0 <br /> plied for ard furthe� agraes to remove same upon notice from t�e <br /> ApprOved for Constructi ate C and to replace public property damage0 t�ereby. <br />� FINA�SF ?IO �Dat� � �� �� <br /> ApD��eE as Conshucted Signature ot A icant Date <br /> 0 PUBLIC WOHKS DEPARTMENT WORK AUTHORI2ED BV THIS PERMIT MUST BE STARTED WITMIN <br /> � 3200CeAerStroet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEA IS TO <br /> BE DILIGENTLV. PURSUED TO COMPLETION.TMIS PERMIT MAV <br /> �orro 25g88�fl' CANCELLED BV THE CITV UPON ANV STOPPAOE OF WORK ON T� <br /> PROJECT OVER 90 DAYS DURATION. <br /> I <br /> 1 <br /> 1 <br /> J <br />