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i <br /> �BtB_.�.�lJ�� vueecW��w�^armn. V� �� <br /> / / <br /> Applleetion For eino oeo+ • <br /> PUBLIC WORKS PERMIY PunolelFae�aa t <br /> Leu�p01 Fea FUE f� <br /> e�i�nce�ue • �'� � <br /> Print or Type Only <br /> �,cep �' /I�.�-�A�,n�f-i� ., �, .,� a�a� - I l��' SE �✓n.,a»�- 9 8�d 3� 7- z�.,� <br /> Owner Malling dd�ess C�ty 2ip P„one <br /> SG w1 Q -- __ <br /> Applitenl Melling Addresa Gty Zip Phona <br /> Deecrlbe Proponed Work b �u�a �Jy�IJ/�N���/� f'a� �7 <br /> - / /r W <br /> ProlectAtldreneplAnown) _ lDSC�J'�— ` Q�ii �p! � <br /> Attach lour(4)cople6 0l plena lor proposad work• Drew to scale end nole Ihe lollowing es epplicable. � <br /> • Property Linen • Cenlerline of street � <br /> • Outlme and dimensions ol ell axlstinB wnd • Indicate North <br /> prnposed sfructures an Ihe lot • Shov�any proposed greding changes <br /> • Exlstln0 and proposod utilities • Show meesurementa � <br /> PO NOT WRITE BELOV'TMIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calle lor Inspectlon ehell be mede 24 hro.In edvence•phone 259•8870. � <br /> 2.All work nhell be peAormed In eccordance with thia pe�mit and current City of Everetl Deslgn end Conetru.11on <br /> 9tenderde end Speclllcetlona. <br /> 3.�:ell Lxotlon Underg�ound Sarvice 4B hra.before you dig.TOLL FREE NUMBER 1•800�424•5,555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br />; <br />'� ACKNOW�.EDGEM[NT OF CONDITIONS <br /> The underelgned owne�/applicent heraby eg�ees to hold and save harm- <br /> -"` tesr. the City of Everett Iror�i nny and alt cleims lor demeges, cosls, <br />' /� eMpenses, or ceu5ns of acllon Ihet mey Brlee beceuse of In6telletlOn <br /> i S 8B and mainfenance ol the improvement or other righl•ol�wey use hereto <br />� eppliad lor and lurther agrees lo remove 6ama upon notice Irom the <br /> Approved lo�Construc i Date Ciry end to reptace puGGc proporty dameged Ihoreby. <br /> 1 <br />!� ��-�c ' ' �//' r/ <br /> FINAIIN C Dele �v_ �--�'`�-� .��'�r�d <br />� Approved ea Conehucted Sipnature ol Applicant Detc <br /> evereC PUBIICWORKSDEPARTMENT WOFlK AU7HORI2ED BY IS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarStreet 'BO DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet�.WA98Y01 BF DILIGENTLV PURSUED f0 COM.PLETION.THIS PERMIT MAV BE <br /> P�one:26B-B810 CANGELLED BV THE CITV UPON ANY STOPPAGE Of WORK ON THIS <br /> , PROJECT OVER 90 DAVS DURATION. <br />