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/� <br /> G/��J j L <br /> Date� J/J 3 Pubi�c Worxi Permit� _�� <br /> � <br /> Applicalion For e�eo oeo� � <br /> PUBLIC WORKS PERMIT Pu�bcWorw�Fee -- <br /> To1eI Pon S— <br /> leff�ool fee PeiC s�_ <br /> Print or Type Only Baiencao�s S 79b— _ <br /> � QOLr /N6 G�•. �e� �3Dx 37l1� .$E�1lLE, ti/9 . 9�lLy �Gf��'11�3 <br /> r aiBng Atldress Cdy �� Zlp Phonu <br /> SM+1Lr fi3 OWNLr�c.. <br /> Applicnnt Mailing Addres5 Ctly Zip Phone <br /> DesCrihe Proposetl Work ���� / ✓ / �� � P`��� <br /> W <br /> Prolecl Address lil known) � <br /> AUach lour�4�copies ol plans�or proposed work- Draw�o scale and note the!ollowing as apPlicable: � <br /> • Property Lmes • Centerline of slreel � <br /> • Outline and tlimensions of all ezisting and • Indicate North <br /> proposed siructures on the lot � Show nny proposed grading changes <br /> • Ezlsfing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE AELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cells lor Inspection shell be mede 24 hrs.In advance•phone 259•8870. � <br /> 2.All work shall be peAormed in aa.ordance with this permil end current City of Everett Design and Construction <br /> Stendards ard Specificatlons. <br /> 3.Cell Locatlen Underground Service 48 hrs.befo�e you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> u <br /> y C c c.�c� ;;c,Ec1� [.✓c>z/� ,�c �e ��in w �� P�rr�v�--- O <br /> n��+uctll �� �i�: ,(c<.(��-(>,cr. C����..a. .�,, 5�— 9— 9.3. � <br /> / /> ,7 <br /> �f �c..r�a;� �Q�(� ,PPL'it�ctir� TrT+� .rC'.�TCC�s[nn-{� 12�7��'vn,r.y , � <br /> O <br /> a <br /> ACKNOIVLEDG[M[NT OF CONDITIONS <br /> Thv und�rsigned owneVapphcant hereby a9rees to hold and save harm- <br /> - less Ihe Cdy ol EvereU Irom any and all clalms lor d�maqes, costs. <br /> ��l' e•penses, a causes o� aclion thal may nrise because ol instellation <br /> ✓ � �y �� �1 �•3 and maintenance ol the improvement or other right�obway use hereto <br /> applieA lor and furiher agrees to remove seme upon notice Irom ihe <br /> Appro �d lor C strucf a�� City nnd to replace public p�ope�ty damaqetl Ihereby, <br /> � y c �d� �.�,....�-�' y�3/y) <br /> FIN IN ION - Da c <br /> qpproved as Constructed S�gnalure of Appli nl Dale <br /> � PUBLICWORKSDEPAFTMENi WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTEO WITHIN <br /> 3200CedarStree� 18U UA`iS OF DATE PERMII IS ISSUED AND THEFEAFTEH IS TO <br /> EverolL WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MP'/ BE <br /> Phone:259�8810 GANCELLED 8V THE GTV UPON ANY STOPPAGE OF WORH(�IJ THIS <br /> PROJ[CT OVER 90 DAVS DURATION. <br />