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—��._Y- . . �t',. �t�`i� " , N��1,e*yfa'�t.1!a�p• -.... :,1� a"_ '�y..4.. ��ai;ifiti7 "�!. <br /> f � <br /> Dat�p� � <br /> Vv � � PUDhcWurbPa�� i �� <br /> Application For eieQ oeo��• <br /> PUBLIC WORKS PERMIT :��blicWorksFee <br /> iotel Fee s <br /> ��ss A�ni ree rw�e S <br /> Print or Type Only Ba�w�_eo�e s_ <br /> � �`r �t (�,t ,�� L�_ ill /) �i�.� % �c� f-�r�.4�.. /7' -Jr4l' %YC=�)vl,:G♦ . _ �i .� ;�r' -^`i �. S�t �'-rS S3� <br /> ��wner Mailing Address City Zip Phone <br /> R,c v��,�r� �J -��i�_ �a� /� ztie. �� �2.U-�7;��� �, Gv� yd'�9G <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work <br /> Jis,�i-c�-:= scrr� �� SOc� '`=" <br /> i — <br /> ProjectAddress�ifknown) `����- �� ��"�`J�/ � <br /> i � <br /> Attach four(41 copies of plans lor proposed work- Draw to scale and note the following as applicable: � <br /> • PioDerty Lines • Centerline of streel � <br /> • Outline and dimens�ons of all exis�ing and • Indicate Norih <br /> proposed structures on the�ot • Show any propos�d grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITt BELOW THIS LINE � <br /> PERMIT CONDITIONF. <br /> t. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be Verformed in accordance with this permit and airrent City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBEA 1•800•424•5555. � <br /> /UC? �:�f'l,G l.J,v�_s /?; i, . � s�=c�r,-,i r G� � <br /> � � <br /> �� ,;; - ,'�`G <br /> .�' �= � <br /> � � <br /> i o�„ <br /> i <br /> 'i ACKNOWLEDGEMENT OF CONDITIONS <br /> �� The undersianed owner/app!icant hereby agrees to hold and save harm- <br /> less Ihe City ot Everett from any and all cl�ims lor damages, costs, <br /> li expenses, or causes of action that may arise because of installation <br /> and maintenanCe of the impwvement or other righ4ot�way use here�o <br /> �I Approved lor Constructiun Date applied for :nd furlher agrees to remove same upon notice irom the <br /> �I Ciry and�o repl2ce public property damaged thereby. <br /> �� FINAL INSPECTION Date <br /> � Approved as Cons�.ructed Signature ol Applicanl Date <br /> everett PUBLIC WORKS DEPARTMENT WORIC AUTHORI2E0 BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cednr Siree� 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION.7HIS PERMIT MAY BE <br /> Phone: 259-6815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJGC7 OVER 90 DAYS DUFATION. <br />