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�a�Q_�QL/ �'u�Lc Worxs Paimit•G. ��'�— "`� � <br /> Application For o�nn ocni .�1]�G�� <br /> PUBLIC WORKS PERMIT P°°:a,aFo�Fea s _ <br /> i less AYG��rce Poid S� <br />� 8alance Due $ �C <br /> Print or Type Only <br />; �r- 1��� �� ��� �-1 r��'�I l.�� �'i r���F -- �.�7-59 <br /> Owner ldailmg Address City Zip Phone <br /> i �r� ���a (�.��al��l��.�P� ��� <br />� p ' an Mai6ng Address City Zip Phone <br /> i �'(- <br /> Describe Proposed Work ��� l�—� <br /> i <br /> Prolect Address(if known) ��C�nc� — ��Syl✓�O� qf/F. � <br /> � <br /> Atlach lour(4)copies of plans for proposed work- Draw to scale and note ihe following as applicable: � <br /> • ProFr.rty Lines • Centerline ot street � <br /> • Oulline and dimensions ol all existing and • Indicate North <br /> p�oposed siructures on�he lot O Show any proposeJ grading chan3es <br /> • Ezisting and proposed utilities • :how measuremenls � <br /> DO NOT WRITE BELOW THIS LIN[ <br /> PERMIT CONDITI�NS O <br /> 7.All calls f or insFeclion shall he made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be FeAormed in accordance with thls permit and current Cily of Everett Desi9n and Construction <br /> Standards antl Specificalions. <br /> �.Call Loc:.tion Underground Service 48 hrs.before you dig.TOLL FREE hUMBER 1-800•424-5555. � <br /> � �Le.�t� �,ce2- '}�-ic.ca� 6ze- Co�rr�nc•ez�ed' Q.�' .�eu,��-' O <br /> �Iria�,✓ .c�ti.�fia.� �,co�� o�/� ��'�'i.�z,cc,� Q,c,�f,. <br /> .S Q�1�,t,�,f do � ��,�� � �// /� � <br /> ..,a � �k' ""`r � /�he- ('orca.L`s u.�o,- <br /> '7'iZC,GC��e� �Gc�� �td ���,J L�CZ�ct ��c.2 c�c�� � <br /> � ' �` 0/� <br /> �e.LO-te. . �f'�j�G��.w„s� Q�n,c� G��OZ.f� o�r✓ �t�� SUc.4'iv_ <br /> J O O f�` <br /> + _1V,,+, ACKNOWLEDGE�IENT OF COIJDITIONS <br /> _(��` —_ The undersigned owner/applicant hereby agrees to hold and save harm� <br /> le,s the City of Evrrett �roin any and all claims lor damages. costs, <br /> .� expenses. or causes of action Ihal may arise because ol inslallation <br /> � �'l �`_ 7�L� .y`� and mainlenance of lhe improvement or other right-of�way use herelo <br /> 'E�7 applied for and fwther a9rees to remove same upon notice Irom ihe <br /> Apprcved lor Co tr�.f n / Date Ciry to replace Ilc property damaged Ihereby. <br /> -��'��- �/�I=�� - � �/7 88 <br /> FIPJAL INSPECTION Date <br /> Approved as Constructed Si� aWre of Ap I� ant Dale <br /> everett PUBLIC WORKSDEPARTMENT RK AUTH�RIZ[D BY THIS PERMIT MUST BE TAR D WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT tS ISSUED AND iHEREAFTER IS 70 <br /> EveretL WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />