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� q� —✓j <br /> 0'atQ ''��6 PUGbc Worke Peima• V� � <br /> Application For BICp.De01.• <br /> PUBLIC WORKS PERMIT P�bl¢WorbPee <br /> Toui Fee s <br /> Less ApP�Fce P�Id s <br /> Print or Type Only y �'� ����`��N e.�.��sn�e S �loG �s _ <br /> �� /3/� N�t✓I�T <br /> ,�PaP� S�lol�/M� 1��4Zf� lN�. E✓pr�7� �� . 98.�v1 .4�+ ��y-.�SC <br /> Ownet Mailing Addres5 City Zip Phone <br /> SAHE �s �3 ��� e <br /> Applicant Mailing Address City Zip Phone <br /> ! �//�� ��//�//j , \ �� � ! <br /> Describe Proposed Work ..,�pZ��o`�'�"��'..,T,� :�n),ii��, . ��� ll�G-1�- . _ <br /> W <br /> P�oject Addree�s pl known) � <br /> Attach lour(4)copies of p�ans for proposed work• Draw to scale and ��ote e following as applica6le: � <br /> • Property Lines • Cenlerline of stree� � <br /> • Outline and dimensions ol all existing and • Indicale North <br /> proposed structures on ihe lot • Show any proposed gtading changes <br /> • Existing and proposed ulilitics • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t. All;,alls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All wo�.�.shell be pertormed in accordance with this permit and current Ciry ol Everett Design and Construction <br /> Standerds and Specificelions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 5! T �F �'o.r�sf,�vcr�✓� .�ti ..4,��,�ovFn O <br /> �.s��F s'<�,� ���F� � -2 0 - �E <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEM[NT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm� <br /> less ihe Cily ol Everet� Irom any and all claims lor damages, cos�s, <br /> -- � j� expenses, or causes of aclion that may nrise because ol instaltation <br /> � and mainlenance ol the improvement or other righFol-way use hereto <br /> applied tor and lurther agrees to remove same upon notice from the <br /> � A prbved�ctio � Date City an to replace public r erry dam�d th eby.� <br /> � 1 /i r <br /> � �� � � ,�.^�- g" �/ <br /> F N Dal <br /> pproved as Cons�ructed SignaturtEol Applicanl at <br /> everett PUBLIC WORKS DEPARTMENT WORN. AU7HORIZED DY THIS PERMIT MUST BE S7ARTED WITIiIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIi IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DIL�^F.NTLY PURSUED TO COMPIETION. THIS PERMIT MAV BE <br /> Phone:259-8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOPK ON THIS <br /> PFOJECT OVER 90 DAYS DURATION. <br />