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Date��Y Pu�L[WO�k6 Pwtmit• f'8 2.38 <br /> Application For ema oaoi.s _ <br /> PUBLIC WORKS PERMIT P��TMeFeeF� � <br /> LefsR00� Fae Veid t q <br /> BaianceCue f G��Q/8 <br /> Print or Type Only <br /> �h�r J N�s,�.�� � <br /> Owner Mailing Address C�ty Zip Phone <br /> — — � nj.s�'�Jv� /7JS /hD�.�I S� /=�vPrv'/� �P1oY ?��-2 //'/ _ <br /> Applicant Mailing Address City Zip Phone <br /> Desc�ibe Proposed Work ��PW ✓'�'� K� �n� ¢�k'm¢'s�O .�i /2�St <br /> �' <br /> W <br /> Projec�AdCress(if known) � «���eze�� � � <br /> Atlach lour(4!copies oi plans for proposed work• Draw to scalW and note the lollowing as applicable: � <br /> • Property Lines - � Centedine ol street � <br /> � Outline and dimensions of all existing and • Intlicate Norih <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show rneasuremenls � I <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> �.All calls for inspection shell be made 24 hrs.in advance•phone 2.r79•8810. � <br /> 2.All work shell be peAormed In accordance with this permit and current City ot Everett Design and Construction <br /> Standerds end Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> y 5.:� �� 6� do�..�rrur�' a,yo'"�/Fz�'...� S�,Pos�I�e'�:osr�s ooaaxo�74 Q <br /> 5, .S,�cQ.� r.P.nyhove,,,o...� .� !se do�,�. .�p /2�.5`f �wveM�l6�61U <br /> � �ro-„�/'.lo,.a. dwt. �-6-�8 o��r.�o ssso.ao � <br /> P1I PC t13o.30 � <br /> �o. .2~ Cua,��✓ �zc� � •�/l,c�at.ci>-� �f/i,�,Q�' .� ��� l814.38 <br /> (1y ,.�.1.� �C't.Ly L<la�`lz% S.�o�'� a.��'i(ii O��.uc,�i�iw, �'�f."'�t60.0 O <br /> a <br /> a <br /> ACNNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> iess the Ciry of [vereft Irom any and all claims for damages, costs, <br /> // �/ eapenses, or causes of action Iha� may arise because ol installation <br /> I �i?��Otr/�L �p �jB and mamtenance ot the imProvemenl or other right-of-way use hereto <br /> applied tor and further agrees to remove same upon notire from the <br /> Approved for Consiruction '� Date Ciry and to replace publ�c properry damaged thereby. <br />;' ---�,��r�� <br /> FINA �NSPECTION Dale SI� '�Y <br /> Approved es Constructed � S��iL9 ature ol Ap icant -G� ( Date <br /> everett PUBLIC WORKS DEPARTMENT �'uRK AUTHORIZED BY THIS PERr IT MUST BE STARTED WITHIN <br /> � 3200CeEarSireel 180 DAYS OF DATE PERMIT IS IS:+UED AND THERE�FTER IS TO <br /> Everet4 WA 98201 BE DILIGENTLY PURSUED TO COMI'LETION.THIS PERMIT MAY BE <br /> Phone:259-BB10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJECT OVER 90 DAVS 6URATION. <br />