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DateJdl � + � <br />��� <br />Applic�Non F.�r <br />IPUBLIIC WORK:% PE:►;MIT <br />Print or Type Only <br />E,�'� litl G�.,'�?i _ 1 � <br />Owner P la.��n9 <br />�.. <br />S N � z- .-. .. - --- - - <br />Appiicant MnP�'tg Addrc�!;s City c„ <br />Pue'�c v:ar4• P�p.a . � "T -'� — •_'�/ � <br />t' � ��'� 7 <br />Ui.q.Devt+_,_! aj—,,_`.1_f�:� <br />Pibl.•.Wods°f0 --_'_---- <br />To:al F . •S __— <br />� ..essAp�1Po•^�if �.__ <br />�❑n.:� Cn Due S ?'�?m — <br />---- ----: <br />r� � 3 �-- <br />G � <br />L�srrl5o .^: �^nsed'��vork ._._\, Y: �J �� 2 c; ��__ -� UU,J ��4 ?�d.J_ �U+2 --- �' �� i.�J �- <br />—�S'E :�_ r=•�+ f ia.�) -- -------- <br />� <br />- , �� `% <br />Phone �— <br />i�hane <br />� <br />Prolect Address ( f known) _� ��%� O/C �?f.' /20�' —<'Z — G9S ;)2OG� iG'�/ <br />Attach four (4) col�ies �n plans lor pioposed work - DreK to scale and note the lollowin{7 as applicable: <br />• Propnrty .'.nes <br />• Outline and tiin�ansions o7 ah existing and <br />proposetl ,tructures on the ict <br />• Existini� •rrd piopo5ed utili�ies <br />PERMI'i CONUITIONS <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed grading rhange5 <br />• Show measurements <br />1. All calls tor inspectioo shall be made 24 hrs in advance - phone 259•881 5. <br />2. All vrork shall be perfor,ned in accordance with this p�:rmil and currenl City ot Everett Design and Constr��ruor <br />Sisnda�ds and Speci!ications <br />3. Cail i.ocation Underground Service 48 hrs. befoie you a�g. TOLL FREE NUMBER 1-800-424-5555. <br />-=�''.�'"�-��a�/8s <br />c�a <br />Approved for Q nstruction � Date <br />�����/��� � � �-� <br />FIN S�:=CTION Date <br />ApproveA us Constructed <br />everett PUBLIC WORKS DF�ARTMENT <br />I � 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />7he undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cit•i ol Everett from any and all claims lor damages, costa <br />expenses, or causes of action that may arise because of installation <br />and main�enance ol the improvemenl or other righFof-way use hereto <br />applied for nnd further agrees to remove same upon notice Irom the <br />Cily and to r2place public property damaged thereby. <br />Sign� Appl' 1 Date <br />WORK AUTIIORI D BY THIS R IT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PLRMIT IS ISSUED AND THEREA�TER IS TO <br />BE DILIGE�ITLI' PURSUED TO COMPLETION. THIS PERAIIT MAY BE <br />CANCELLEU BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT GVER 90 DAYS DURATION. <br />