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u <br />� <br />Date��U <br />i � <br />� <br />PUB�C' <br />Prini or Type Only � <br />O <br />M <br />�—���(J-"J <br />Application For <br />l�1IC�Ri4S PERMIT <br />l('1 OpO �{�. O O Ot�A} <br />.N—� O N� W N � M IA <br />� tl! M � � � � � M <br />i Owner \ ` � 8'� �'� ��r�dsa � �aE � cS5 `'��y <br />�li N4 1 `� Ci� <br />Applicant Mailing Address Y <br />� <br />/ <br />Public Nbrks Permll s ��n � <br />emg. oeo�. • ���7�� Zs"d� � <br />PubIICWCrk5FC0 g <br />Total fee <br />Less Appl. Fee PaiJ g <br />Balance Due � G� <br />�rir� ��aqo 5'8i �s <br />Phone <br />Phone <br />� Lv-r 1 �� �2oz-5 i- �.9 <br />Describe Proposed Work <br />Project Address lif known) - <br />Attach four (4) copies of plans for proposed work - D�aw to scale and note„Cenite Ilne ef stpPeii able: <br />• Property Lines • Indicate Nor�h <br />• Outline and dimensions of a�l existing and � ghow any pioposed greding changes <br />proposed siruc�ures on the Ict � Show mexsurements <br />• ExistinF and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be peAormed in accordance with this permit and currenl City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />FINAL INSPGCTION <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone: �59�8870 <br />UGIC <br />ACKNOWIEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />Z <br />O <br />■ <br />N <br />O <br />a <br />The undersigned owner/applicant hereby a9rees to hold and save harm- <br />less the City oi Everett from any and all claims for damages, costs, <br />expenses, o: caus�:s of aclion that may arise bacause ol installalion <br />and n�aintenance c�i ihe improvemenl or other righl-of-way use hereto <br />applied tor and furlher agrees lo remove same upon notice irom the <br />Citya'/fd�f o replaOce public �� damaged thereby. <br />--t� l ).�1 "vr ✓ -v_ <br />Sig � r ot Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE[� WIThiIIJ <br />180 DAYS OF CATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. Tr1iS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK GN THIS <br />PROJECT OVER 90 DAYS DURATION. <br />