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Dale�p � ' _ P„�,�,�v,�,�s�.,,�n� , , ^I p- - <br /> Applicalion For e�n� Deo� • .— �-L/-�(�_ . <br /> FQ ___ _ _ <br /> / <br /> PUBLIC WORKS PERMIT �'°°�°W°,�=F°� -- . <br /> ro�,�Fe� s_ <br /> LeSS Fppl FqC PqiO S <br /> e<i,��P o„„ 5 _ <br /> Print or Type Only — <br /> LI cyc� � ���tr+�/ l 72�i /�„� 7�- <br /> �ner Madmg Adtlre City 7ip Phone <br /> "-qppp�y❑� Mailing Addre55 Cdy Z�p Phnnc <br /> Descri�e ProG�sed Work _�'t7��� n �1���(�� —_— <br /> � <br /> � !1� <br /> Proiect Address lil knowr.l �� 7—�� ���-- �I <br /> Attach lour(4) copies o� plans lor proposed work� Draw to scale and nc te Ihe following as applicable�. � <br /> • Property Line; • Centerline of street /A <br /> • Oud�ne and dimension; ol all ezisting and • indicale Norih y� <br /> proposed siructures m� the lot • Show any proposed grading changes <br /> • Existmg and p�oposed utilities � Show measuremen�s � <br /> � DO �JOT WRITE BELON'THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance-phone 259•8810. ^ <br /> 2.All work shall be pedormed in accordance wi�h this permit and current Ciry oi Everetl Design and Consiruction ♦ <br /> Standards and Specilications. <br /> 3.Call Location Under9round Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> — � ' �, O <br /> 1 :�uV 1""c'-�-l�l 1 l ��''� �{'-� � <br /> ^, V♦ <br /> ,� .��,C� �� l�""�e�_ <br /> � �� . �. � c� �/� <br /> Ys <br /> ,1CK,VOVJL[DG[td[NT OF CONDITIONS <br /> The „ndeisiqned owneVapplicant hereby agrees to hold and save hann- <br /> -- �-- I less the City N Everetl Irom any and all claims lor dam�9es. costs. <br /> expenses. or causes of action that may arise because of instollation <br /> and maintenance of Ihe Improvement or other nghbol-way use herMo <br /> --.— applied for and furiher agrees to remove same upon nohcc Irom thc <br /> Apprc��rd lor Constructlon �';��<> City and to replace public property dama9ed thereby. <br /> FINAL INSPECTION ��,i`= — — <br /> AFP�oved as Consiructed Signalure of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everelt PUBLICWORKSDEFARTMENT �yp DAYS OF DATE PERMIT IS ISSUED 4ND THEREAFT[R IS TO <br /> � 3<COC=darSlrcei 8E DILIGENTLY PURSUED TO COM1IPLETION. THIS PERMIT tv1AY B[ <br /> Everett WA 99201 CANCELL[D BY THE CITY UFON ANY 9TOPPAGE O°�VORK ON THIS <br /> Phone:259�&610 PROJ[CT OV[R 90 DAYd UURATION. <br />