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�3�e� BV Publm WorFSPcrmil a �/ � —/�G� _ <br /> �� Applicalion For o�aq.Oepi.s ___ <br /> PUBLIC WORKS PERMIT Pubi¢WorksFeo <br /> .o�a�F�o s— <br /> L�55 AOPI FCe PaiU S <br /> Print or Type Only e.,�,,�«o�,• s a0� <br /> .�30� C�/-/�t1nJ I/ �/ /0%if�/-t/G s�.�,sa� S�� ��/a� �z,�—�� <br /> Owner Mai{ing Addre55 City Zip Phone <br /> zr�r-94ge <br /> Applicant ' ����Mail�Add�ess City Zip Phone <br /> DescribeProposedWork � O / ��U� �.(�i"/LL �/V �/L�N� �S�y��__ <br /> �s�. ,� , ���n� oF ��NN��� D�r �s- ci v�--�v <br /> V�Z�(�,fCU�j�{iICE ?ZJ .A'U/LJ� TFfI� Lt/�LL <br /> �/ / p /� W <br /> Project Address(il known) /� Q N � �U��/ � ��` � <br /> Attach lour(4)coU�es of plans for proposed work- Draw to scale and nofe the lollowing as applicable: �� <br /> • Property Lines • Centerline ot street J� <br /> • Outline and dimension;ol all existing and i Indiwte Norih �j <br /> proposed s�iuCtures on ihe lOt • ShOw any proposed grading r.hanqes <br /> • ExisGng and proposed utilities • Shcw measurem�Ms � <br /> DO NOT WRITE BELOIY THIS LINE <br /> PERMIT CONDI�IOkS O <br /> t All calls tor inspection shall be made 2a hrs.in advance-nhone 259•8810. � <br /> 7.All woik shall be peAormed in acwrdance with�his permit and current City ol Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Gall Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � C mr/1z��� /�.viL �'c�� ;S't-__��,�%z-� �.�'�5� o <br /> � <br /> � <br /> 0 <br /> L� <br /> ACKIJOWLEDG[Iv1ENi OF CONDITIUNS <br /> 1 he undcis�:ined owner/epplicaM here6y agrees In hol�1 and savr harm- <br /> — less the City ol Everett Irom any and all claims for dama9es, cosic� <br /> _ //i��� i7� (� / exPenses. or causes ol action !hal maY arise because of installation <br /> ��Y ��� e�d maintenance ol ihe improvement or other right�ol�way use hereto <br /> g applied lor and lurther agrees to remove same upon notice trom Ihe <br /> nnn<<����d icr y nsirudion Date <br /> / � City and t e ace pu6lic p erly c 9ed ihereby. <br /> / '�_ �� . .�����''/� �J �� �� <br /> �rtJAL INSPECTIO � �Date <br /> %�nP�oved as Construc�ed � Sign ture ol AppGcant Date <br /> i�c��rett PUBLIC WORKSDEPARTMENT W�RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarSireet 180 DAYS OF DA7E PERMIT IS ISSUED AND iHEREAFTER IS TO <br /> Everett.WA38201 BE DILIGENTLY PURSUED TO COMPLETIO!.I. THIS PER�dIT A1AY �� <br /> Pr.one.259�6910 CANCELLED BY THE CRY UPON 4NY STOPPAG[�F l'JORK ON TFii; <br /> PROJEC', OVEF 90 DAYS DUR,;TION <br />