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Date'' � �� � <br />Application For <br />PUBLIC WORl�S F�ERMIT <br />Print or Type Orly <br />C�.� �l �,�.- -f--- <br />Owner <br />f' /� i � <br />:�.pplicant <br />r— <br />Describe Prcposed Work ��� <br />.� <br />�. � o <br />Project Address (if known) G– <br />1 <br />G�- `7 � � � <br />Mailing Address <br />i <br />�_`j// � <br />Mailing Address <br />/// 1 <br />v✓f J'c//� C/ <br />Pu��mVlo:ksPem��ta J�� G�T /— <br />Aldy Depl. a — <br />FuLLc VJOrks FeC <br />,o,�� F�� <br />�essann� Feo Paitl � � <br />9alnnce Due <br />`%v>�fi � C. ��1'— ���7G � <br />Zip Phone <br />Ci�y Zip <br />i <br />.�J%.G� �F3G- �_- <br />.-� / �c �_`7"�'�;� <br />_ �_'�-• <br />Phone <br />/� �. <br />Atiach inur (4) copies o� plans tor proposed work - Draw to scale and note the lolloviing as apPlicable�, <br />• Froperty Lines • Centerline ol sireet <br />i Outline and dimensions of all existing and • Indicate Norih <br />proposed siructures on �he lot • Snow any proposed grading changes <br />• Existing and proposed Wilities • Show measwemeNs <br />THIS IINE <br />"�RMIT CONDITIONS <br />'�,. All calls for inspection chall be made 24 hrs. in advance � phone 259•881 5. <br />2. All work shall be perlormed in accordance with ihis permit and current Ciry ot Everett Design and Sonstruction <br />Standards and Specifications. <br />3. Cali Location Underground Service A8 hrs. before you di9. TOLL FREE NUMBER 1•800•424-5555. <br />everetl PUBLIC WORKS C °PARTNENT <br />� 3200 Cedar Sireet <br />Everelt, WA 96201 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby ac�rees lo hold and save harm� <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arisr� hecause ol installation <br />and maintenance ol the improvement or other right�ol-way use nereto <br />applied tor and furlher agrees to remove same upon notice Irom the <br />City and �o replace qqublic ruperty dama9ed ther^by. <br />i <br />/��� � � / �% <br />/� a �� >��( � J�` � �C/� / <br />Signatu/r� of Applicant bate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARlED WITHIN <br />780 DAYS OF DATE FERMIT IS ISSUED A'JD THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WO 'N THIS <br />PROJcCT OVER 9G DAYS DURATION. <br />