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�8�e—.LLLO � /—�� PubLC WO�k�Permil• � <br /> / " L� T�, <br /> ApplicetiOn FOr ema.oao��• 7 6 �_� '1 U`��' <br /> PUBLIC WORKS PERMIT PueTot�Fee��� : <br /> Lene�oDl Fee F�ie S <br /> Be4nceDua s <br /> Print orType Only <br /> _1���k C .� 1'>'1elr�d�� l�, Lr.rnc ��� Coot7.D�/ ��° Rnv��'I� Q�a ./�.� <br /> Owner Mailing Address Gty Zip Phone <br /> �„q.wl., <br /> Applicent Mailing Atldiess Cty Lp Phone <br /> Describe Proposed Work �.(1�1`� �IM �/r1��,1 /N_I ��. �f�(� �f ! ( <br /> Pro�ect Atldress pf known� _���01— l�A�.lJ1. PY � <br /> Attech four(4)Copies of plans for proposed work• Draw to scale end nole the lollowing as appliceble�. � <br /> • Property Lines • Cenledine of slreel � <br /> • Outline end dimenolons ol all existing and • Indicate North <br /> proposad etruCtures on the lot • Show any proposed gradinp chenges <br /> • Exleting and proposed u�ilities • Show measurements � <br /> DO NOT WR�TE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for Inapectlon ahell be mede 24 hra.in advance�phone 259•8810. � <br /> 2.All work ahetl be peAormod In eccordance wilh this permit and cunent City of Everett Dealgn end Construction <br /> Standarda end Specllicalions. <br /> 3.Cell Locetion Undarground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> {-'/W PE�z�ii r Ncr K� O <br /> �oe�.�.� �l'1� K� � <br /> 3 / S / 9Ci N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applic&nt hereby agrees lo hold and save hnrm• <br /> -- less Ihe Gly ol Everelt I�om any and all claims for damagas, costs, <br /> expunses, o� causes of ar.lion thel may adse because of insteltetion <br /> and maintenance ol the im�rovemen� or othe� right�oi-way use herato <br /> -- applied lor and lurlher ogrees to remove same upon nolice from Ihe <br /> Approved for Gonstruction Oa�e Ciry and to replar.e puhlic prope�ty damaged Ihereby <br /> FINAL INSPECTION Da1e <br /> Approved as Consirucled Signalure ol Applicant Dale <br /> everett PUBLIC WORKS DEPAR�f!v1ENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CadarSlree� 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EvaratC WA BB201 BE DILIGENiLV PUkSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phona:259�BB10 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVEF 9G DAYS DURATION. <br />