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i <br /> �8te����S' Poeue v:orb v�rmu� ___47r�!��et_� <br /> Applicatlon For xiea.oeo���`� <br /> PUBLIC WORKS PERMIT ^�°;W�:F.. � <br /> L�u ADD�F��V�id � <br /> an.M.o�. t_�•OO <br /> Print or Type Only �Q•� <br /> • . oD�ae. �.3� = �`'t�-�zt" 3_� <br /> wner MaiNngAddresa Clly Zip f•hono <br /> �_�_/o y h��� 9�z ��� �3,�J'-6cT,� � <br /> ���� Malllnp Addresa Clty Zip Phone ,., <br /> C'1 <br /> 1� T <br /> Describe Proposed Work _� �`-<< ��� <br /> ..... <br /> H � <br /> � ~� <br /> W � <br /> Pro�ect Address Uf known) ����� �� � �� <br /> Att�ch four(1)coples ol plans fo�propoaed work•Draw to ecale and note the lollowing as epDliceble: � �� <br /> •Propsrty Lines • Centerline ol etreet � m,,,� <br /> •OutPne and dlmenelone ol sll ealatinp and • Indicate North g= <br /> proposed atructures on the lot • Show any propoaed prading chanpea �� <br /> . • Exletinn and proDoeed utllitlee � Show meeeurementa M �„��,,,� <br /> �� W � <br /> N T WRIT 8EL W THI LINE O �� <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspectlon shall be made 24 hra In edvence•phona 280•6815. � <br /> 2. All work ehe�l be pedormed In ecco�dence w!th ihia permdt and currenl City ol Everett Oeeign and Conatructlon m"" <br /> H <br /> Standarde and 9pecllicatlona SZ � <br /> 3. Call Locatlon Underpround Servlce 48 hre.before you dlg.TOLL FREE NUMBBR 1-800�4�4•b6S6. � �N <br /> H <br /> O �r <br /> m <br /> � <br /> � s <br /> � _ <br /> O N <br /> a � <br /> r� <br /> �n��„ ACKNOWLEDGEMENT OF CONDITIONS <br /> ��� The underelgned owner/applicenl hereby aprees to hold end eave herm• <br /> leas lhe Ci�y of Everett Irom eny and all clalme lor damape& costs, <br /> / exponse& or cauaes ol ection Ihat mey e�ise beCaule o� Instellatlon <br /> �^�/ 1� _ L' /_��,8 and malntenence ol the Improvement or other rlght•nl-way use hereto <br /> l.rd0'�/�" (� applied lor and lurtl�er agreea :o removo same upon nolice Irom •he <br /> ApProved for Con ructlon �a�a Cily and to replace public property damaged therehy. <br /> /\3�s�� ���� �� ' . ���"""�'_ " _`f' �O/2 7/a Sr <br /> AL NSPEC110N Dete <br /> Approved as Constructed ' ature of Apolicanl Date <br /> everelt PUBLIC WORKS DEPAR7MENT ORK AUTHORIZED BY THIS PERMI7 MUST BE STARiED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Slreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,N'A 98201 CANCCLLED BY THE CITY UPO� ANY STOPPAGE OF WORK ON Th11S <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURIITION. <br />