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n <br /> � ' <br /> Datr � � a � Pu�lic Works PermE x `-� � �� _ <br /> -5 .,� <br /> BIEB��ept+ <br /> Application For <br /> RJBLlC WI/ORKS PER11lyl'i' PuDTo:aIFooFee � <br /> LesS ApP�Fee Paltl $—'_ n <br /> BaldnLeDuB aJ `�_� �I <br /> Prin[ or T•. ,�e Only <br /> I <br /> � <br /> �'. � � >� s �s�;, ;�, 3 �� ;•r l ��,-,�.��; ��o � 3373� iy � <br /> Owner Mailing Address City Zip Phonr: <br /> �( / / � i / ! / / <br /> Applicant Mailing AGidress Ciry 2ip Phone ' <br /> __ II <br /> Describe P�oposed Work /1-PSl,�^>,�-! r' yc'�l7 -�` _ I <br /> i <br /> I <br /> _ � <br /> �.: <br /> �31J 5<= -- — W <br /> Project Addres&(if knuwn) ���'- /�'�NiL !r/oKs�/ i'L. _ '�dT `�'� � <br /> D� /'.C,.1, a$ <br /> At!ach fow(4) r.opies ot plans fer w�oposed��mrk- Draw to sr.ale ard note�he lolle++ing as applicable: � <br /> • Property Lines � • Cen!erline ol street � <br /> • Oulline and dimensions ot all existing and O Indkate North <br /> propused slruclurzs on he lot • Show any proposed�rading changes <br /> • Exi,ting and propoced �lities • Sliow measurements � <br /> �m-�—_ ll0 NOT WFITE�rC��HIS LIME � <br /> PEfiM1T CONDITIO':o <br /> 1. Ali c�l;s for inspa:tion shall be made 24 hrs. In advanc� � plione 259•$81 5. � <br /> 2. All work shall be performed in accortlanc=with thi;permit:�d currenl City of Everett Desi�n and Cor.struciicn <br /> Stanjards and Specifications. <br /> 3. Call Location Undergroi�nd Ser+ice�a nrs.b?{ore ycu d 7,I�OLL,FREE NUMBER �•800-424-b555. p�� <br /> o� <br /> f� <br /> � <br /> �w <br /> _/ <br /> 0 <br /> � <br /> ACF.NOWLECi;EMEPIT OF CGNDIT`ONS <br /> [�� '� The�nderslgned o�,c:i��r;a�nnlirant hereby a;�ee' ':nold and save harm- <br /> —�L._—'"._ — __—_ <br /> --� lese tk City of EvereS: from xny and all clgima 'or damages, costs, <br /> ,/ expensea, or cai�ses ol acfion that may anse becau<e ol installafon <br /> ( /�/i _ `�I� �� and mainteranr,E oYthe �mF�rovemenl or othei r'gl;t-of-way u;= iiereto <br /> ��=���e7�! � y/a� � apGlied for and furtF.�cr agrezs to rer ave same unon nohce fcom the <br /> .4pproved'or Constr �t� Date Ciry antl to•eplar.e��bli�proG<rty damaged thereDy. <br /> �i�• C�'zy� a <br /> FINALI SF CTION Dale �C ./�.l.���7�__,, ,___���cL_�� <br /> Fppre'�ed a::Censtruc.atl Siynature of Applicanl ���o <br /> everett PUBLICIN�RKSDCPARTMENT I WORY AUTHORIZED BV Thlla P!'^"" MUST��BE STARTED WITHIN <br /> � 3200 Cad�r S':eel 180 DAYS OF DATF PERMIT I: �J ANG T•1ERLAFTER !P, �6 <br /> BE D'�ILIGENTLY PURSUED TU C:�MPLETION. ��Ii:F PE?"d1T MAY BE <br /> Evere�t,WA 9,7201 �qN%,ELLED 9Y';;��ITY UPJN AVY STOaPAG:Or YJORK�JN THIS <br /> Phone: 259-8�315 h.�OJECT CiVER 50 DAYS �VRATIO �. <br /> � <br /> � <br />\ � • <br />