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� `� <br /> � � f <br /> I <br /> II <br /> � <br /> Date u /� �/ Puhl¢WorMs Pe�mn a -V/ —�O� � <br /> p1�4.Depl.+ <br /> Application For <br /> PUBLIC WORKS PERMIT °°°"`"`°'"s`°° --- <br /> ro�Tii�u s-- <br /> �ess Ap01.Fee Pni� 5 <br /> 0alanceDue � ���- <br /> Print or Type Only <br /> A9v�o f3sr/a2. <br /> lar��.e.f��,�c-T��� �'is' / /,Q'���l�. s� ,Q�((cv�� �,��/Ol �.lJ -/6JG - <br /> Dy,��ef Mailing Aodress Ci�y Zip Phone <br /> fc�w.� c.t c�6v✓� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Wark /�"C �J+�I-�� fG�T��J � � ���^ �-'-� r'' � � �'� � <br /> Q'f S �� c (.� /-tc.� ei (i��s�' G� �� �� nr,�;.i Qlc.�c. . <br /> W <br /> '� ' 1 / /� J�r ,�c L2 U�� � <br /> Project Address lil known) � <br /> Attach lour(4) copies of plans for proposed work- Draw lo scale and note�he lollowing as apPlicable: � <br /> • Properry Lines • Centerline ol streel � <br /> • Outline and dimensions ol all existing and • Indicale North <br /> proposed slructures onthelot • Show any proposed gratling changes <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <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•8810. � <br /> 2.All work shall be per(ormed in accordance with this permit and current City of Everett Design and Construclion <br /> Standards and Specifications. <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> �D,e� To �E1>oNC Pr.e I'L.9� � �f'o.�v�� B'� O <br /> i��- �,-y �z��,� w��.� ��; o,� 8-��-89 <br /> <G��y h'ir�i/.ED,� ♦�^ <br /> V♦ <br /> O <br /> a , <br /> ACKNOWLEDGEMENT OF CONDITIONS �'I <br /> The undersigned owner/applicant hereby agrees to hold and save harm� �' <br /> — less the City ol Everett from any and all claims lor damages, costs. ; <br /> expenses, or causes of action that may arise bec2use of installation � <br /> � `/ � /s�/., p and maintenance of the improvemenl or other right-of•way use hereto <br /> i7�!"U �Oo�" � U-��o—U'9 applied for and furiher agrees to remove same upon notice from the � <br /> Approved for Construclion � Date City and to replace public properry damaged thereby. <br /> ��� ��� � � � � ��,c���� ��i� �'/��/,�9 ' <br /> FIN� L t S �ION ' Dale . <br /> qpproved as Consirucled Si�naWre ot Applicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PUBLICWORKSDEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet 8E UILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 6E I <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STnPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br /> r <br /> I <br /> � <br /> I <br />