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,_ <br /> ----ff �� /�� --: ' m.2�►2� ��upr �-��35 <br /> `����8t@�� Pu01ie Works Permll• � <br /> ' � BICq.DeO��• <br /> Applicatfon For . <br /> PUBCIC WORKS PERMIT P°°To;Fe F� .� <br /> � . Lsas AppL Fea PaIE {_ <br /> � Beience ous s ��'{�— <br /> � rPrint or Type Only <br /> :� <br /> ; '��, v���n�gti.� �aC� F� rl�r ���F�2rr� 9�c111 a5a- ar5� <br /> �o Meiling Addr sa City Zip Phons <br /> C iw N►1�D <br /> . y <br /> °�Applicent Meiling Address City Zip Ahone � <br /> � DetCriba Propoeed Work J1�L`.L=�d� �� �� °a`-^c.ti��L� ' <br /> V <br /> . W <br /> Itrohct Address(H known) �OS/S— El/E.PG.PEEit/ L�Jf.Jt/ � <br /> _ Ld' <br /> .i�lt�ch fau(4)Copbs of plana for propoaed work-Uraw to acele and note the following as applicable: SP. �� �� � <br /> ' �.� ._,` �p�Ry���e8 . • Centedine of street � <br /> �"" � •Outllns�nd dimenslons of all eztsting and • Indicate North <br /> 3 i, <br /> -;propMed tlnicturoe on the lot � 3how a proposed grading chanpea <br /> '�%�.� •EzldMy�ntl propwed utllities � Show me uremen!s <br /> �" <br /> � ��-; � � �� DO NOT WRITE BEL W THI LINE � • <br /> PEFiMIT CONDITIONS r O� <br /> ` 1. AU calle fa Mapectfon ahall be mede 24 hra In advance- phone 259-g815. � � <br /> '���_' � 2, AN work ah�ll be pedormed In acwrdance with thls permlt end curren4 Ciry of Everett Design and Cpnatri�ctlon � <br /> `� ,.�. ' Stand�rd��nd SPedflcetlons i'� <br /> �, 3. Gll locatbn Underground Servlctf,48 hrs.before you dlg.TOLl�i1EE NUMBEB 1-800-424•5555. � <br /> �:; � -¢• j-�- �,�,a,,�1�,�.s �d��`'���� 0 <br /> .. . I-- <br /> , N <br /> O <br /> , a <br /> . �� � ACKNOWLEDGEMENT OF CONDITIONS <br /> �'��:. -� � The undersigned owneUappllcant hereby agrees to hold and eave herm- <br /> . leas the Clty of Everett from any and ell clalme tor demaqea, coatA <br /> �''��� �� � �axpensea or cauaea oF ection thet may aNne beceuce o� Installatlon <br /> 1�" , <br /> °�i�-- �i and malntenance of the Improvement or other rlghbof-wey use hereto <br /> ��%��'�- � � epplied for and further agreea to remove eame upon nc�lce from the <br /> � d �r on Dete Clty and ro replace pub opeAy demaped thereby. <br /> ,rs,'�:• �J� Q��� � � �^ (' <br /> ECTIO Date "" �"___E"��-Z/^�" <br /> r�y,�MWW M,Cenatruct 31 neture of Ap fcent Dat <br /> %'-� RlBUC VNDRK5 DEPARTMENT WORK AUTHORIZED BY THIb PERMIT MUST BE STARTED WITHIN <br /> :��=8200C�r8MN 180 DAYS OF DATE PEHMIT IS �S3UED AND THERFAFTER IS TO <br /> � �i�:.� EyN�tt,WA$8201 BE DILI6ENTLY PURSUED TO COMPLETION.THIS PENMIT MAY BE <br /> � �+;:�.�Phorw:�35W8816 CANCELIED BYTHE CITY UPON P.NV STOPPA(iE Of WORK ON THI3 <br /> PFOJECT OVER 90 DAYS DURATION. y _ <br />