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Date 1�z2/92 <br /> .-. <br /> rom�c w�,k,a„mn. <br /> Application f or aiaa oeci . 35417 <br /> PUBLIC WORKS PERMIT P�o��=Wo,k,F�, <br /> Total Fea S-� <br /> Less AOVt Fea PeiO .S�� <br /> Print or Type Only eaia a o e s <br /> �— <br /> E.P. Oil 33305 First Sdy S Federal [day 98003 874-7515 <br /> Owner Mailing Address <br /> City Zip Phone <br /> 1im Iiarrison 323-4144 <br /> Applicant Mailing Address City <br /> Z�P Phone <br /> D^scribe Proposed Work Install Sta e II va or recover lines reima e cano with round ed es <br /> Project Addiess(if known) _ W <br /> Attacb four(41 copies of plans lor proposed work• Draw to scale and nnte the following as aUplicable: � <br /> • Prope�ty Lines • Centerline ol streel � <br /> • Out�ine and dimensions ol all ezisting and � <br /> preposed struclures on the lot � �ndicale North <br /> • Exi;;ting and p�oposed utilities • Show any proposed grading changes <br /> � Show measuremenls <br /> DO NOT WRI7E BEIOW THIS LINE m <br /> PERMITCONDIiIONS � <br /> 1.All celis tor inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All wonc shall be pedormed in accordance with this permit and current City ol Everett Design and Construdion � <br /> Standards and Specifications. <br /> 3.Call Location UnJerground Service 4B hrs.before you dig.TOLL FREE NIIMBER 1•80p-QQ4•5555. <br /> � <br /> O <br /> �� ��� i� ���'✓�.S � �F1 Z � --�— �v.�— Y����:-, �^f.� � <br /> ���� ��1 �✓ � <br /> � -- � — � <br /> � , �__ a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> —�-- The undersigned owner/appiicant here6y agrees to hold and save harm� <br /> less the City ot Everett trnm any and all clriirs for dnmages, cosls, <br /> expenses, or causes of achon Ihal may arise becausa ol installation <br /> and maintenance of the imprwement or other right�ol-way use hereto <br /> Approved lor Construclion Date applied lor and lurther agre2s to remove same i,pun ne'ice Irom the <br /> Ciry and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> Signature ol Applican' Date <br /> �I�� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WI7HIN <br /> �._. 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PUR��UED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:259-8810 CANCELLED BY THE LITY UPON ANl'STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATIO�. <br />