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Date�.+Z,3�d`�° ,�:�,�.�w�,�s�,.,m�:p�; .7� ��� - 'f�/ <br /> oiao.oeoi.• � � /�'�Q�— <br /> Appliwtion For -� . <br /> PUBLIC VI�ORKS PERMIT P�oucWonevee <br /> toiel Fee S <br /> �r�ss nno� reo Pe�tl S <br /> e.,�rnsel���. 5 an�'� <br /> Print or Type Only <br /> �A�Cv'Q� \on� �2����=' C'�� 'C\1OQ'c� � q�c.,i�C��� ��\�� � <br /> Owner Mading Address Gity Zip Phone <br /> �'.�1�1'f <br /> Applicant Mailing Address City 2ip Phone <br /> . \ `1 � <br /> Describe P�oposed Work ���1 ���c�uc"�" <br />� p W <br /> Prolect Add�ess Iil known) �� J� � U.�T (�G<�� � <br /> Attach lour(4)copies ot plans lor proposed work- Draw to scale and no ihe lollowing as applicable: e <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed slructures on the lol • Show any proposed grading changcs <br /> • Exicting and proposed utilities A Show measurements � <br /> DO NOT WRITE BFL.OW THIS LINE <br /> PERMIT CONDITIONS O <br /> t. All calls tor mspection shall be made 24 hrs. in ativance-phone 259-881 5. � <br /> 2. NI wo�k shall be perlormed in accorriance with Ihis permit and current City ol Everett Desiqn and Construction <br /> Standards and Specilic�tions. <br /> 3. Call Location Untle�ground Se:vice 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 5! �c>o,� vt.�✓E �E�� s,TF ���.✓ s� .,,..,rre o il//Q�, O <br /> � <br /> � <br /> O <br /> a <br /> AC�WGWIEDGEMEIJT OF CONDITIONS <br /> The undcrsigned owner/applicanl heie�y ayrees to hold and save hainr <br /> less ihe City of Everetl Irom any and all claims for damagr,s. costs. <br /> expenses, or causes of action Ihat may arise because ol installation <br /> ��� y J� �2 �� 6 and maintenance of the Improvement or other right-ol�way use hereto <br /> Approved for Con�— ate applied 1or and lurther a999�,�s to remove sama upon notice Irom the <br /> City and to replace publidprbperly damaged Ihereby. <br /> ic�"� / 1 � <br /> �' � S-.LL-i� C J G'C���`�J����L e -, �. <br /> FiNAL i SPECTION Date _ <br /> Approved as Conslwded " ignature ol Applicant Date <br /> evrrett PUBUC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone: 259�8815 CANCELLED BY TNE.,TY UPON ANV STOPPAGE OF WOFK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />