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� <br /> �8�e �(" ! i Yl Publlc Worka Parmit Y �`� — �� <br /> �_y�c �r �i <br /> Application For emp.oao�.r <br /> PUBLIC WORKS PERMIT P�bIiCWorklFeB <br /> ro�a�Faa s <br /> LB55 Rp01.F80 Peitl S <br /> aa�a��a o�a a 20—� <br /> P►int or Type Only <br /> �1�.�.=Pagl�� S3o"1 i3� �U� S� .�'rY�{�in,rni`G �-a� <br /> Owner\ Mailing Address C�ty Zip Phone <br /> � � <br /> ppplicant Maiiing Address Ctly Zip Phone <br /> DeseriCe Proposed Work 1 �'�1� 1 �f K— l �� � l�lt.0 � K � .s�� � <br /> W <br /> t ProjectAdtlresslif!cnown) Z320 - AoAms A✓E � <br /> i dttach four(4)copies ot D�ans for proposed work-Draw to scale and note the following as applicable: � <br /> • PropertY Lines •Centerline of sireet � � � <br /> •OuUine z.nd tlimensions ot all existing and • Indicate North I <br /> proposed structures on the lot • Show any proposed grading changes . <br /> •Existing and proposed utilities • Show measurements � -� <br /> DO NOT WRITE BELOW THl LINE O ` <br /> PERMIT CONDITIONS <br /> 1.All Calls for inspection shall be made 24 hrs.in advance-phone$59-8810. � ,` <br /> 2.All work ahall be peAormetl in accordanee with this permit and current City of Everett Design and Constructioo � <br /> Standards and Specifications. <br /> 3.Call Location Under9round Service 48 hrs.before you dig.TOLI FREE NUMBER 1-800424•5555. � , <br /> O <br /> � <br /> � <br /> O <br /> a <br /> . ACKNQWLEDGEMENT OF CONDITIONS <br /> The untlersigned owner/applicant hereby agrees to holC anA save harm- <br /> less t�e Ciry of Everett from any ar�tl all claims 1or Aemages, coat& <br /> ezpenses, o� causes of aclion that may arise because o� installation <br /> — a en0 maintenanCe oi the improvement or Othar right-of-way use �e.reto <br /> � applied for and further agreas to remove same upon notice from the <br /> Apprpvpd for Conatruc � ity and ro replace public property damaged therady. <br /> O 1� � � �lt/ Q$ <br /> FI 90 O Date . <br /> Apprwsd aa ConstructeA Si nature of A �cant bate <br /> �� PUBLIC WORK9DEPARTMEN? WORK AUTHORIZEO BV TMIS PERMIT MUST BE 3TARTED WITHIN <br /> 3200Cedn8treet iB0 DAVS OF DATE PERMIT IS ISSUED AND TMEREAFTER IS TO <br /> ,'{\ � E��W��� BE OILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> � Plia�e:2648810 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. , <br />