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i <br /> ; <br /> �8��� Pv�lw Work�Permll/ � �� <br /> Applicatlon FOr � eiap oec� • Jr <br /> PUBLIC WORKS PERMIT A+�I�cWad�Fee <br /> Tot�i F�e � <br /> Leu AOV�.Fea P��U � <br /> I B�bnceDw � ���� <br /> Print or Type Only <br /> 7 9z 6'� <br /> .S /t, �r ��// �uo1__n � � i lrrf/ �� <br /> Owner MaillnpAddress / Cily� � Lp Phone <br /> P ne Ps /37��,�w �r �. ,� ors�,s,�,�9b -��/.�l'.>/� <br /> Applicent Mailing Ad reas Clty Zip Phone <br /> �eacrib ropoae Woik �( ��f' s' � �/`�! //DUS�QN f�N� . <br /> e <br /> A�,�/ W <br /> Pro�ect Addresa(II known) /3.?G /� � <br /> Attech(our(4)coplea of plans for proposed work- Oraw to acale end note the lollowing es applicable: � <br /> • Property Linee • Cenlerline of street � <br /> • Outline end dimeneians ol all exlsling and � Indicate North <br /> proposed st�ucluree on the lot • Show any proposed gretling chenqes <br /> • E�letlnp end propoaed utillties • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cetls lor Inepectlon ahall be mede 24 h�s. In edvence-phone 259•881.�i. � <br /> 2. All work ehell be perlormed in eccordence with tnle permil and cu�ront City of Everett Design and Conslructlon <br /> Standerda end Speclflcetlona <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicent hereby egrees to hold and save herm• <br /> less Ine City ol Everett Irom any and all clalms lor damega& coata, <br /> �-�//� _ _ /`7 ezpenses, or causea ol ection thal mey arise hecause ol Inateltallon <br /> ����� �� � end maintenance ol Ihe Improvemant or other right•o4wey une hereto <br /> �� ������ epplied lor and lurl r agrees to remove same upon notice Irom Ihe <br /> Approved lor Conslrucl n ate City an to r placr, ubGc property demeBed ihereby. <br /> ��:�3-�� � <br /> FI INSPECTION Da�e <br /> Approved ae Conetructed Signalure ol Applicanl pe e <br /> everelt PUBLIC WORNS DEPARTMENT WORK AUTHORIZED BY TNIS ERMIT MUST dE ST TED WITHIN <br /> � 3200 Ceda�S�reot I80 DAl'S OF DATE PERMI��� i5 ISSI�CU AN6 THFI7EAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLV PURSUED TO CrMPLETION. 7HI i P'_f'MIT MAY BE <br /> Phone: 259�BB15 CANC[LLED BY THE CITV I��ON ANV STOPPAGE UF 1VORK ON THIS <br /> PROJECT OVEP 90 DP':S DURATION. <br />