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Date �`f �W������ PublicWorksPormit• �7- 2�3 <br /> Application For <br /> eiao.oac�.• <br /> PUBLIC WORKS PERMIT P°°To,aFooFBe : <br /> Lass AOD�Fce Paid S�— <br /> ea�enceo�u a '��n <br /> Print or Type Only <br /> (��:�woe�� ClirllLC� S��JIC�/J`JMailing aa/s 1!//I1QCi/lc Yi�JY.�/' �Yc�'F'1y�P /Ui�. .PnoG /�7`> <br /> App�icant Mailing Address City Zip Phone <br /> Describe PioposeA Work 5,��� �'� O � OT ��UC.�`J�=� �lS�U.S LL4L� l,lI7.C�L�'brus/ li"1 <br /> (.r D✓ .a IL[�Yk-f� . <br /> W <br /> Project Address(if known) E" �"1<< Ai'� - ✓�t��'�f /o� 75�,E o�' DO vE,� � <br /> o SociTi� S�oE <br /> Attach four(4�copies of plans for proposed work• Draw to scale and note the follo ng as applicable: � <br /> • Property Lines • Centerline of street � <br /> � • Outline end dimensions of all existing and • Indicate North <br /> proposed siructures on ihe lot • Show any proposed grading chenges <br /> � Existing and proposed utilities • Show ineasurements � <br /> DO NOT VJRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All wark shall be performed in accordance wi�h this permit and current City of Everett Design and Construction <br /> Standards and Specificatio�s <br /> 3. Call Locetion Undergrou�d Service 48 hra belore you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> y �j,tif/ ��;Ta.c Ekc��s�r�o�✓wo.�°,t is �v BF do.v.� o.✓��/ O <br /> Af'rE,�z Bv��o�.v�� ��.�.+.�c N�✓� B�e�.�/ su.a��.rrE.� �,vo <br /> yPf',zo��.�o, � <br /> .S %�s .9,P,�� is To dF .5�y�a s,�faFo !.�/iry �,�9s.s N <br /> W.Ty.�/ 3o D,qys ��%.F.2 c�EAk,ti�G /.� ���,Cv„✓v O <br /> �'o.�.Sr,evcTio.✓ f/�s �,o�- 8�'Guti�,. � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apFlicant hereby agrees to hold and save harm- <br /> less the City of Everett froin any and all claims lor damages, costs, <br /> expenses, or causes of action ihat may arise because of installation <br /> 7 _� �� and maintenance of the improvement or other right•of-way use hereto <br /> � �'� applied for and furiher agrees to remove same upon notice irom the <br /> A rp4e for C stru ' n Date City and to replaca public property damaged thereby. <br /> l <br /> � 7r'— �-f7 0 � <br /> FINA SPECTION Date � <br /> Approved as Conslructed Sig ture ot Appticant Da e <br /> everett PUBLIC WORKS DEPARTIAENT WORK AUTHORIZED THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP. IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />