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D81B��� P„ni�r Wons ne,mn. � <br /> Application For emo oen� • � <br /> PUBLIC WORKS PERMIT PubTol�fee`ae : <br /> leea�nol feePeitl s . <br /> PninnrnDu• S <br /> Print or Type Only — <br /> N�Pi� � �� q �r�s^A rn ��E�rr q82o3 �!7_,�321 <br /> Owner MaiIInB Address Cily Zip Phone <br /> ��Tr ���. �r� F-v�RGQEE�1 ��;a��� q�2n3 363-��61 <br /> Applicant Meiling Address City Zlp Phona <br /> DeecrlbaProposedWork �p�L ( - Tu���nK� <br /> W <br /> Pro�ecl Addreae pl known) ��Zq ��-A��- �� ' � <br /> Attech lour(4�coplas of plene for proposed work•Drew to ecale end note the lollowing ae eppllcebte: � <br /> • PropeAy Linen • Canterline ol alreel � <br /> • Outline and dimenalons ol ell exlating and • Indicate North <br /> propoeed etru�turea on Ihe lot • Show eny propoeed greding chenges <br /> • Exlating end proposed ulilitlae • Show measu�emente � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells fo:Inspection ehell be made 24 hra In edvance-phone 259•88�5. � <br /> 2. All work ahall be perlormed in eccordanca with thie parmN and current City ol Everett Design end Construclion <br /> Slendarde and SDecllicatlona <br /> 3. Call Locetion Underground Service 48 hrs.belore you dlg.TOLL FREE NUMBER 1-800•424•5555. � <br /> ! `�i"/C� /c��.r',tS /-��i^�i .i�'T .�F�f!'4.('FO SF ��97 O <br /> '�,li�✓ <br /> H <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENTOFCONDITIONS <br /> The undersigned owner/epplicant hereby aBrees to hold and neve harm- <br /> — less ihe City of Everett from eny end all clelms for damages, cosle, <br /> expen9e.5, or causes ol BctiOn thal may B�ise bnCause ol Instelletion <br /> and meinlenence of the improvement o�other right�ol�way use hereto <br /> applied lor end further agrees to removn same upon notice Irom the <br /> Approved 10�Cu islruclim� Dete City and!o replaca public property demr,ged thereby. <br /> FINAL INSPEC7iON Oale <br /> Approved es Constru;ted Signalure ol Applicant Date <br /> everetl PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BV THIS PERMIT MUSi BE STARTED WITHIN <br /> � 3200 Ceo�r Sireel 180 DAVS OF DATE PERMIT IS ISSUED AND THERE�FTER IS TO <br /> Eve�ett.WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Pho�n��. 2E 3�8815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PRGJECT OVER 90 DAYS DURATION. <br />