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Date,�{p`J�O Pu01¢Works Pa�mil s � ��� <br /> _� <br /> AppliCation For eme�oeo��+ Z.Q Z Q�_ <br />= PUBLIC WORKS PERMIT °�����w���•F�a <br /> ,o�e�Fae s_ <br /> �ess noot Fee ram S <br /> Print or Type Only ea�ance oue S� <br /> w ; il��►+^ (.�./2PJP/' If.as- �G��,gF ,E✓v��� 33�/-�f�33 <br /> Ownei MaiNng Addr ss City Zip � pryo�e <br /> V lON NQy� � �ell�f/'L�N\/ 7n C ����F �MILEK !.�< � � �ic� 7 O�L� 3s - ��aa <br /> Appl�Cant Madrng Adtlress City Zip Phone <br /> DeBCribePfOPosedWurk /�[Q, S�uaIP /,j.����/ QmE1�=�T" � g�nc.� � �ii.�h b1F�u� <br /> Project Atltlress(if know��j a�a s - R��.� � � <br /> Atlach fow(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Proper,y '�ines Y Centedine of street � <br /> • Outline antl�imensions of all existing antl • Indicate North � <br /> proposetl structures on the lot • Show any proposed grading chan9es <br /> • Existing and proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•$$10. � <br /> 2.All work shall be peAormetl in accordance with this permit and current City ot Everett Design and Constructio� <br /> Standar�antl Spec'rfications. <br /> 3.Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1•$00-4245555. � <br /> � � .s:�a-� L�T �7 �� ,���r O <br /> s��e�- s�P � �,� �. � <br /> �) ,���- �.� �. .� � w� �.� O <br /> Q. <br /> ACKNOWLEDGEMENT OF CGNDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any antl all claims for damages, costs, <br /> �L/ /�� ����� expenses. or causes of action that may arise because of installation <br /> l,l/1� ,and maintenance of the improvemer+t or other right-of-way use hereto <br /> ApprovediorConstr�cY n � � applied (or and fwt�er agrees to remove same upon notice from the <br /> �Q Date �'�,City aqd to replac public property damaged the�eby. <br /> �� (� � O <br /> /.1 -/'CL / J `� <br />.. FI!!AL INSPECTION Date /��'� � (/ _�/�.�_.�� �� ',��� � <br /> Approved as Conatructed Signature of pplicant Date <br /> 0 VUBLIC WORK30EPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CeGar3treel 180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> E+erett WA88201 BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Fhona:25&8870 CANCELLED BV THE CIiY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DUFATION. <br />