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Date��r � Public WorW Permll R __F�/�� <br /> Applicatiun For eido�oeo�.•_ � � <br /> PU�LIC VIOOF�KS PERM�T /�f�qbs Pu�lieWorksFea _ <br /> .a�a�Fea s <br /> � �ens aao�Fea Pe�a S� <br /> Print or Type Only B'�a°`°o"° a h�� <br /> l_es lJcar- ���,� l�. ��oU�wi.u �,;eref-f �1�d0/ �j�l -c�o7 � <br /> Owner Meiling Address Ci�y Zip phone <br /> Le5 �/Pa r dd3o1 /U.� a .fve�� - l�;D! 33�/ -0(�7�_ <br /> Applicant Mailing Address City Zip Phor.e <br /> Describe Proposed Work �il� /'�_�c- f� /i'��i��a r �Pn/�/� �, ,�L/�i� <br /> Project Address(if known) i v�� � L � <br /> � <br /> Attach tour(4)copies ot plens for proposed work• Draw to scale and note the tollcwing as applicatle: w� <br /> • Property Lines O Centerlinz of street � ��A, <br /> i Outline and dimensions of all exist�ng and • Indicate North �d <br /> proposed struclures on the lot � • Show any proposed�ra�ing changes <br /> • Eristing and proposed utilities • Show measurements � <br /> �� <br /> �O NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1, All calls lor inspection shall be made 24 hrs. in advance-phone 259•$Ci1 5. � <br /> 2. AV work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground�ervice 48 hrs. before you�Jig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �� /�,� ��� ,��jo/ �� �� � ��/-�s' � <br /> �- <br /> � <br /> � <br /> � <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> T;;e undersi�ned owner/applicant hereby agrees to hold and save harm- <br /> less lhe City ol Everetl irom any and all claims for damages, cest=, <br /> ' / expenses, or causes of action that may arise because of installation <br /> 1/z_L�,� and maintenance of Ihe improvement or other right-ol-way use hereto <br /> s,� / / �7`— GL7 applied for and further agrees to remove same upon notice Irom !he <br /> Apnroved�nstruction �a�e Ciry�3nd to replace public property damage�i thereby. <br /> ��i-�-�' `�� I �/ �i�_ <br /> FINAL INS ECTION Date " <br /> Appwved as Constructed � nature of Applicant Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERNIT MUST BE SThRTED WITHIN <br /> � 3200 Cedar Street 780 DAYS OF DATE PERMIT IS ISSUED AND THEF;EAFTER IS Tn <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMI7 t.IAY BE <br /> Phone: 259-8875 CANCELLED BY THE CI7Y UPON ANY STOPPAG�OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> � , _.. . _._._ . -. - ,,. <br /> . � . .� ., ,.. .. . <br />� ' ' �. �,:� .. ., .„ ,�,.. <br /> ��.r���''�'?s` .�.r���r��R�:sa��e. s- � ,..n„,. ..:. <br /> ...gi ` � <br />