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_ , <br /> Date ��`� PUEpcWarbPermtl• �s—�77 <br /> ApDlication For eiev oeo�.• <br /> PUBLIC WQRKS PERMIT °°^°°W°�.F�° <br /> .o,a�F�e s <br /> Leas Aoo�Fee Puo S <br /> Print orType Only ea�a�«o�e S 3->=� <br /> Owner ldailing Address City Zip Phone <br /> ,��1;�r,�.�i �1.v�.,�� �,� i c7 ��o.��w ci,�� ���ti,z� 2�'L� 7��2'L z <br /> oplicant Mailing Address City Zip Phone -�i <br /> 1 " <br /> ��'�-w wa,,.� m <br /> Desc.ibe Proposed Work �L� �" � <br /> --1 �7 <br /> .-� --� <br /> N S <br /> W m <br /> � o <br /> � mo <br /> Project Addrese(if known) �� <br /> om <br /> Attach fom(4)copies o1 plans for proposed wrk- Draw to scale and note the following as applicable: � ...� Z <br /> • Property Lines • Cenlerline ol sireet � m � <br /> • Outline and dimensions of all existing and • Indicate Norih � <br /> proposed structures on the lot • Show any proposed grading changes c <br /> • Existing and proposed utiliti��s • Show measuremenis � � _ <br /> 1 H <br /> DO NOT WRITE BELOW THiS LINE -< T <br /> PERMIT CONDITIONS o � D <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•BB1 5. � --I m <br /> 2. All work ahall be performed in acwrdance with this permil and current City ol Evemtt Design and Conslruction m ,._, <br /> Standarda and Specifications. �^ <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � o r <br /> c� m <br /> l. .��.�'/!/�`Lv.CI� 3 vNi <br /> T'U L5'C I/d�ACCCO O �� <br /> /���c' C'i�y STiJ�.L�4/'G"� � �''G% �Ti/�CC/EO� ' �" <br /> i � � A <br /> x <br /> � a <br /> z <br /> -i <br /> O .. <br /> � <br /> a Z <br /> 0 <br /> � <br /> n <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City ol Everett irom any and all claims lor damages, costs, <br /> expenses, or causes ol adion ihat may arise because ol installalion <br /> -���CR�� ���/or5 and mainlenance of the improvemeM or other righbof-way use hereto <br /> � ✓ri o applied for and further agrees to remove same upon notice irom ihe <br /> Approved tor ruction �'ate City and to replace public p�operty damaged �hereby. <br /> �� �Od�a i3 -�-� �(/� <br /> FIN►NNSPEC110N Date M' v�M ✓Vl/?y"�-� <br /> Approved as Constructed Signature 1 Applicant Date <br /> everelt PUBLIC WOFiKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE START[D WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-BH15 CANCELL[D OY 111E CITY UPON�NY STOPPAG[OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />