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i <br /> ) : , <br /> PupLt WOrb Por • � � I� � <br /> Date. lLr�2�'-� � -- — <br /> Application For em� neo�.• <br /> PUBLIC WORKS PERMIT P���� ;A,�QFeO $ � — <br /> Lxss Ana��Fee Paia S <br /> � /'�� <br /> Balance0ue $_{� <br /> Print or Type Only <br /> _�C�La_��`�l�l�—( 111 �'1�1� � <br /> wner Mailing AAdress �Ci y 2ip Phone �I <br /> !L N ' <br /> Applicant Mailing Atldress City ZiP Phone � <br /> �7 ,�J'!� f �] ��//]] I <br /> Describe Proposed Work �l ���� �—YK-� L.(�L��/ ��- "---�� J` � � � <br /> v <br /> I W <br /> ProjectAddress�ifknown) �� ��0 ���-��-Q.�u%�✓ `��"� � <br /> Attach four(4)copies ol plans for proposed work- Draw to;cale and note the tollowing as a�Ulicable: � <br /> • Property Lines • Centerline of street � � <br /> • Outline and dimensions of all existing and • Indicate North <br /> � proposetl siruc�ures on�he lot • Show any proposed grading changes <br /> • Existmg and proposed uti6ties • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Conslruction <br /> � Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> Y .�G`L�' JL fCC.-Y�-�.p, l�.GC,�G((i•`2� t(_�'JJt�—Y�. 2,.cC' -2i:fC-�!t(�. O <br /> L,:.�t`/t: �C�L�/ /�e-c,��' CK-2I. �/ <br /> � <br /> ! � <br /> s Cl,�l�L .SS�=Gfn��( � �'X�if�lCc�� �.�'`I'•�e1�7����J'.Yt-x�.•s�� <br /> �/ � � <br /> (� S�r�P �� O <br /> � � � o,�,� a <br /> �� o � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned o�vner/applicant hereby agrees lo hold and save harm� <br /> less the Cily of Everelt Irom any and all claims lor damages, costs. <br /> expenses, or wuses of action Ihat may arise because of installation <br /> �y�p �� � I _ -z_ �O.G and maintenance of the improvemenl or other right-ol�way use hereto <br /> 1 f� � U � a lied for and lurther agrees lo remove same upon nolice irom the <br /> Approved lor Conslruction Date ity nd to replace public property tlamaged thereby. <br /> FINAL INSPECTION Date �J�1��� � <br /> Approved as Constructed Signaiure o Applicant Date <br /> WOFK A� ORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURS'JED TO :OMPLE710N.THIS P[RMIT MAY BE <br /> Everett,WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�0810 PROJECT OVER 90 DAYS DURATION. <br />