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Dgt@ �/y�J� F� VubllcWorkaPermit+ � ��/ <br /> ��`� <br /> BICO.DaO�.� <br /> Application For <br /> PUBLIC WORKS PERMIT PuetatalFae�eB s <br /> Less ApG�Fee PeiE S <br /> a.�.��a o�a s 3s� <br /> Print or Type Only <br /> ller�r] P �'► Arol nl��`� 1 Z06�-1 ecv� �F- C—✓eiet� 9�zo�l z�2—�,Si 6 <br /> Owner Mailing Address City Zip Phone <br /> I <br /> �pp��p� Meiling Address Cdy Zip Phone , <br /> .. Oencrlbe ProPosed Work {,,.�,��Q '.+�^=--�C I1 ��" (/��1I`�[��I ���iG7T�- �i <br /> � <br /> i <br /> I <br /> I <br /> W � <br /> � Pro1�1 Addre6a(11 known) H � <br /> Att�ch(our(1)coplee o(plana for proposed work•Drew to scale and note the lollowing es applicable: � � <br /> • Property Lines . • Centerline of street � <br /> •Outline and dimensiona ot all eaisting and • Indicate North <br /> proposed atructures on the lot • Show any proposed greding chenpea <br /> • Exl�tinp end proposed utilftlee � Show measurementa M <br /> W <br /> DO N T WRITE BELOW THIS LINE O <br /> PERMIT CONDITONS <br /> 1. All cells lor Inapection ehall be made 2a hra in advence-phone 259•8815. <br /> 2. All work shdl ba peAortned In eccordance with this permit and current City of Everett Design and Conatmction � ; <br /> Stand�rda and SpedBcationn ' <br /> 3. GII L x�tlon Underpround Service 48 hra before you dig.TOLL FHEE NUMBER 1•800�424•5555. � I <br /> i <br /> �! s.rE tva.P,t- To dF vo�v� �r_�,e .9o�,eov�o O <br /> �oT f�A.r/ �DA�D //i7 g� I <br /> � i <br /> O <br /> > a ; <br /> � � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold end save herm• I <br /> less ihe City of Everett from any and ell cleims for damegea, coat& <br /> � � ��✓ ezpenses, or ceuses of action thet mey arise beceuse of inatalletian <br /> /��'�B� and maintenence of the improvement or other right-of•way use hereto <br /> applied tor and further agrees to remove same upon notice from the <br /> Approved for Construc ate City and reptece Public property dameged thereby. <br /> ��-- �o fl f` _ � —/6-�7 <br /> FINAL INSPECTION Date � <br /> Approved es Constructed Si a ure of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �� PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � � 3200 Ceder Slreet BE DILIGENTIY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everat6 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />