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Date �-i�95 <br />Anplicalion For <br />PUBLIC WORKS P�€iMlT <br />Print or Type Only <br />ner <br />n,,���� a n,�ures <br />Cdy <br />SaM� _'__ <br />APPhcant PA.,din<:Add,�•cs Gr,✓ <br />�.,��.,v�,.,a�,m,,, vs��o7 <br />o�nv neci , <br />�'u1�hc Wo�4s Frc <br />To'pl [np �J <br />105501i111 fn.�Vai�J �J <br />���,,��,. n�„ 5 � D—�— <br />o6Z-32240/383/ <br />Phonr. <br />Z�a Phone <br />Q.. <br />DescriUe Pronosrd 1No�k _�Q _./�/4.(1L�_/_(o___%/�EE�S _ _�QF�10J��___��i°O�_, _�,1�0�GqJ'y _,�� <br />f� LlCEiu��il /�UDtu/1�rtf3L--- --------- --- — — -- <br />Projr.c� Addre551�1 knowN __(p1,1� _ �'QL�y_�i%C _��L�� i{/I7___ <br />AttaCh bur14) coP�es of Plans Im p�oposeJ �e���k - ��av- 1:, -�-.�I...��,i not�, th��'oni„vmy as apUhr.ab�r <br />• Property L�neS • Cun�rrlino nf slree� <br />• Outhne and dimensions of all exishnq ond • hdicatc North <br />M�Gosed sirudures on ihe �u� Y She�w any cronosetl raradmq yv3n;��-y <br />Y EriSting and propo5ed uiildies •.S'hna mr.,�suremen�p; <br />L <br />PERMIT CONDITIONS <br />1. All calle tor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peilc�med in accordance with ihls permit and currenl City ol Everett Design and Conslruction <br />Standa�ds and Specilicalion;. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />// /iC�Z�J Ci�y �S�r�e�' CLe�r� n-� �« f�,�cS _ <br />�PUBLIC WORKS DENAFTMENT <br />3200 CetlarStree� <br />[verett, WA 98201 <br />Phone�259�8810 <br />ACKNOVJLEDGEIAENT OP CONDITIONS <br />/� <br />� <br />� <br />� <br />i <br />� <br />O <br />a <br />The undH�sianed owneNapphcant hereby ag�ees'� hold anU sace h,arm� <br />I�•,s Ihe Gty of Evr.reU trom any and all daims lor dam.�9us. cost� <br />urqenses o� causes of actwn that may aris= because ol installat�rn <br />and mainlenance n! the improvement or other n9hl�of-way use he�eto <br />ar.pi�cd for ano turther a�7rees to remove same upon nohce Irom Ihe <br />I: ', ,�nd ;n i!•pince public proDe�ly Jamaged ihereby. <br />__��+c[�'� � 8 /D —9� <br />Sign,3iwe ol AnPliran! Datc <br />11�ORK AUTHCRIZED BY THIS PERA9IT IdUST 6E STARTED WITHIN <br />1g0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIUGENTLI' PURSU[D TO COMPL[TION. THIS PERMIT tdAY B[ <br />C.NC[LLEU BV TNE CITY UPON i+IJY STOPPAGE OF VJORK ON THIS <br />P�76.iECT OVER �JO DAVS pUR4T10N. <br />