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�<�Y��9� "pn��,r:monFor G'Lil . �. . . <br /> PUBLfC WORKS FERMIT °��° �`� �'' /`� ` , <br /> � PUALIC 170RKS DFPARiI."E.'!T Pu6tic Vlorks Pertnrl k ��%/-��� <br /> 3200 Cledar SVeet ��(,�[�f���..QIp� <br /> Ece�etl,VlF:98201 259�A810 (���iidiny Permil#_ _ ___ . _ _ <br /> � �r <br /> TYPE OR PRINT ONL:' Pubi�c V:orks Pee S �'J� �l�___ <br /> _J�� / / � <br /> �.�� !��( '�;:i�%P�� %�%�j �/� ,Ifs� Z��2���! �/��o�: :� 5�' % �!�� - <br /> Owner Mailing Address Ci�y ip Phone <br /> f,�OJ� � �7�g-/fj'J.� <br /> Applicant Matlmg Atldress City Zip Phone <br /> / <br /> Describe Proposed Work �.���4�' i'� i o �__ :�G2 .''/"i i .,�; �''�_—_____ 1 1 1 <br /> -' J i`ii <br /> - _-- -- - — — I� <br /> � <br /> - --- -- - — ------ V♦ <br /> PROJECT ADDRESS Qf known) � i 3 Z- �Q�^ �G%^� Q� - _—___ — M <br /> A';aUi!our(J�copie;ot plans for proposed werx- Dravi lo scaie a��ef nofe ihe lollowing if applicable: `i' <br /> •Prop?rty Lines •Outline antl d�mensioos of a!I exisimg and proposed struclures on Ihe lot 'Ezisting acd pmposed wihr.es O <br /> °Centedlne of street •Intl;cate Nonh •Show any proposed 9rading change, •Show measuremems � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection sh��! be made 24 hours in advance - phone 259-8810. O <br /> 2. All work shall be performed in accordance with this permit and current City o( Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM[iER 1-B00-424-5555. ` <br /> r <br /> � G,Jo,� -�o ,Z� a/o�� �- a�P.�o���/ ��C�:�� � <br /> a�4 �¢� /- �7-y'9 . �co,o� q�f4c%,� � <br /> ,, , � � <br /> J . �� C��y �S}��--�e�s �(el :�i �1 4L� �'t,�--,`'c�3' .��.,��_'� <br /> . ,, :? - :,) <br /> ���cS== _ , � - -�:-..,.. .5,.;i�� - - <br /> _ -_ .; .,.. <br /> � :•�i; <br /> � 5 � � . - - <br /> � � <br /> � _�� l�GKNOI'i1.LUGFh1ENi OF CONUIT10NS <br /> /'� '��� � The undersigneA owner/apphcar! tiereby agrees to hold antl save harmless <br /> i �i�� ��799 the City ol Everetl Irom any and all claims lor damages, cosls,expense;, or <br /> �� � ;l'ry-�'� / �— tauses ol action that may arise becawe of mstailation and maintenance ol <br /> ilppro�ed f�Gons�� ��e the improvemenl or olher right-of-way use hemto apphcd for and lun her agrees <br /> / . to remove same upon nohce from the City and to �eplace puhlic piuperty <br /> ' damaged theieby. <br /> FINAL INSPECiION Datc n , i .' . <br /> �pprovetl as Cans�mcted �� � ./ / �� � -. , -�; <br /> � / � i/ � � �.:,i� `- . `� �, <br /> j, l.�/�(/%.:.. � .'. `.�i� , <br /> Sgnalure ol Appliwnt Date <br /> NlORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COh1PLEf10N. iHlS�°RMIT h1AV BE CANCELLED DY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECi OVER 90 UAYS DUHlQION <br />