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<br /> . Applica�ion For � 3��» o r� . _
<br /> ' PUBLiC WORKS P�RM1T ���,����=W�,�=��� - - `
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<br /> �,, Descrbe ProPosed Work 1 /'7 ,�7�i ,_�_Q, p�-�vLl� ,/ U/7- O� 4 �c
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<br />*'*' ; Prolecl Address Iil knownl c� � /l��r _ �
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<br /> ; Attach fow(4)copies of Ulans lor proposed work - Draw to scuir,ind nole th��following as applicabie�.
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<br /> ' 1, • Properly Lines • Canterline of ,treet
<br /> • OuUine nnd dimensions ol all exishng intl • Intlicate North � .,��;
<br /> proposed shuctures on thc lot • Show any proposed grading chanpr•; r> *.�
<br /> • Exis�ins and proposed utilitie� • Show measuremen�s �`"�� •
<br /> �� i DO NOT WRITE 8[LOW iHIS LWE ��
<br />{ _ PEHMITCONDITIONS � �"`
<br /> _ _.,", 1.All calls lor inspection shall be made 24 hrs.in advance-n��one 259-8810. �
<br /> 2.All work shall be performed in accordance,vith ihis permit and current City of Everett D^sign antl Ccnstruction �� � F��
<br /> y E %�' Standards and Specifications.
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<br /> r 3,Call Loca�ion Underground Service 48 hrs,before you diq.TOLL FREE NUMBER 1-800•424•$555,
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<br /> Y +�� � ACKNOVJLEDGEM[NT OF CONDITIONS ��
<br /> vp i _ ,_ �' The under5ignca ov.�ner/apphcant hereby agrees to hold antl sa�e hnrm
<br />�✓Ir.�, l � less Ihe Cdy ot Everett from any and all clalms tor damagcs � �s�: � .�
<br /> r'� ' � % I expenses. or causes ol action Ihat may ans^ bec�use ol in t dl ,t. �
<br />��, � '- �F�� -,.� ���1, /_� �� l��),- I dnd niamtenance of the improvement or other r:ghbof��•:;i u n �n��, �
<br /> : :vovetl fcrConstruct�on - — I np?hed for and further agrees to remove same upo�i �:.��• �•, m �; `w.
<br /> � �� ����` � C�ty and to replaccip�•'���c properiy darnaged thereUy `�'y�
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<br />'"w�/�', ':AL INSPECTION -- - — ' i
<br /> 4� Date � �1 �k`.�_"��' k�`�
<br /> ��'.�rovetl as Consiruc�r,d --- —p----- �
<br /> v4 ," SignaWre of App�l int
<br /> .,�*^ j '-�� PUBLICWORKSDEPART�dENT WORK AUTHORI .ED BY THIS PERPAIT MUST �E STARTED INITHIN
<br />'ro��, � > �� 3200CedarSveet lA0 DAYS OF DATE PERtd1T IS ISSUED AND THEREAFTEF I`.: 7�0
<br />. .fi�;^'�� ��� Evc�etL VJA 9E201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERfaI i I tA�� BE
<br /> ,�( Phnn��. 259-HFiO C�NCELLED BV TH(S CITY tIPnN ANV STOPpAGE OFC:�R'��: ��fe' �l-{IS
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