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1 <br /> _ . . S� - 346 <br /> �atA . . Puelic worka Pe�mit• — <br /> / BIEB.pePi.r ���d�� <br /> Q B P Applicatlon For <br /> PUBLIC WORKS PERMiT Publit�.'orkfFee — <br /> ToulFeo s <br /> �eSa AOt�Fee Paia s_—�--- <br /> 88100CNOV8 S �O� <br /> Print or Type Only — <br /> --�'i�-I— <br /> � ' �S`�O S G! �"�=� S��. El�. ��,� _ �5�,� �I�r 1. <br /> ���i� . �ti1 c�l� �_. <br /> Owner Maili g Atldress City 2ip Phon� � <br /> n /� / I, 1'� -- <br /> I ,� , � � L( ✓ C' 70rj 'C /v %N jW (_ 1� WV . �SOZp l.�1�� <br /> Wl"...�_C�fv 7✓�.�1L�JCi ���- <br /> Applicer�t MailingAddress Cily Zip Phone <br /> Describe Proposed Work <br /> (\1 -r_�� �' ������.��T;o,J �� rV��� Z ,�.� <br /> /6/� — �o�ti E: <br /> ,�dsg.�'- E�GErn%e �N. <br /> --��-�,r �,�J, <br /> ,�C���.-��� • �i� Ge�-,�:v -��� C L <br /> Project Address(if known) � <br /> r <br /> Attech lour(4)copies ol plans for proposed work• Oraw to scale and note�he following as applicable: � <br /> � Property Liies • Centerline of streel � <br /> • O�tline and dimensions ol all existing and • Indicate North <br /> proposcd:;lructures on the IM � Show any proposed grading chanqes <br /> • Exist�ng and proposed utilities • Show measurements � <br /> DO NPT WRITE BELOW THIS LINE O <br /> PERMIT CUNDITIONS <br /> 1. All calls to-inspection shell be made 24 hrs,in advance-phone 259•Ei81 5. � <br /> 2. All work shnll be performed in accordance wilh this permit and current City of Everett Design and Construction <br /> Standards and Specificetions <br /> � 3. Call Location Undorground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiyned owner/applicant hereby agrees to hold and save harm• <br /> less the City ol Everett irom any and all claims tor damages, costs, <br /> expenses, or causes of action that may arise because ol inslallation <br /> ���� � /�6 and maintenance ol the improvement or other righhol-way use hereto <br /> applied for and fu h agrees lo remove same upon notice Irom the <br /> o�e�for Consiruction _ �'; � / Date CitY a t r P e Pu lic ProPe ty 9etl thereby. <br /> %� // r^' /� <br /> . / %� � b V N,i B '7 $ 4 <br /> IN ION D te <br /> as Constiucted Signa re ot A plicant Date <br /> WORK AU7HORIZED BY THIS PERMIT MUST BE STA TED WITHIN <br /> � PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PFlOJECT OVER 90 DAYS DURATION. <br />