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� �8t@�`����' PUGbc WorA�Perm�t a <br /> i . Application For eiaq oeo� •— _ <br /> ' PUBLIC WORKS PERMIT P�����W���F�� <br /> To�eiFee s <br /> Leas ADo�Fee PaiC S .9 _ <br /> Pflflt O(Typ@ Of1Iy ealence Due s N� ���.e�*'� <br /> �no�F,� r,Qo�� �i� a4+� A„� s�t� � aa�z2. 324-3060 <br /> Owner Mailing Address City 2ip Phone <br /> t.Est��rn i uk�2 113�i 34-`�'�� 5�Q,{� q Q i 22 32y -3obo <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposeCWork ����1L1�(11✓ 1�0�� r�� 1C10`C — rilb �Ell) 1� � <br /> GG�F.rn�tan �'[ernme�er I�s �i7n-�� FoR- 4-b r►an�urrl Tr�2nti <br /> Prolect Address(if known) � �fr 1 � <br /> � <br /> Attach lour(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines � Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures an the lot • Show any proposed grading changes <br /> • Existing and Droposed utilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> • PERMITCONDITIONS <br /> � 1. All calis for inspection shall be made 24 hrs. in advance-phone 259•8815. � <br /> 2. All work shall be pertormed in accordance with this permit and current City of E�erett Design and Construction <br /> � StanOards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. betore you Aig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> � <br /> � O <br /> i � S �'�- C 1 � �'v �J < v s' �'z �� <br /> � � �-�� S 1 , t-� - � � s � � � <br /> T <br /> �� O <br /> r��� � � �s a <br /> - ,� ACKNOWLEDGEMENT OF CONDITIONS <br /> — —�:' � <br /> .c,� „ p-a � �l The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City ol Everett Irom any and all claims for damages, cosis, <br /> ezpenses, or causes of action that may arise because of installation <br /> and maintenance ot Ihe Imprevement or other right-obway use hereto <br /> applied for and furiher agrees tn remove same upon noticc from the <br /> Approved ior Construction Date City and to replace pubGc properry damaged thereby. <br /> � ,a��- �'s-� <br /> FfI�AL INSPECTION Date <br /> Approved as Consiructed Signature ol Applicant Date <br /> everett �UBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedur Street 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98201 BE OILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANGELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />