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Date.(yC]�L I Pu�litWo�ksPermii+ ��� � <br /> Application For eiae�oeo��y <br /> � <br /> PI�BLIC WORKS PERMIT �°b��°�y°�h°F°a <br /> Tolnl Fee s <br /> Lesa ApO�Fee Peltl $ <br /> Print or Type Oniy Ba�,�=a o�a a ��—� <br /> �1 (�4 kQ.r �o� �P��L ����r ,�� �Rao� �3-��r�� <br /> Owner Mailin�Address City 2ip Phone <br /> �SiYt.!��i Ol�l ,��55� . ��(X� �I(� �v�. �. P���l I q� I �l 8 I—I 1.�'L <br /> Appiicant Maiting Addres:> City Zip Phone <br /> Describe Proposed Work ���_ <br /> W <br /> Project Address(if knewn) � <br /> Attach Iour(4)copies ol plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Propeity Lines • Centerline of street � <br /> • Out!ine and dimensions of all ezisting and • Indicate North <br /> proposed structures on the�ot • Show any proposed greding changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMtT CONDITIONS <br /> 1. All call,for inspeclion shall be made 24 hrs. in advance-phone 259•881 S. � <br /> 2. i II work shall be perlormed in accordance with this permil and current Ciry ol Everett Desian and Construction <br /> Standards and Specificationa <br /> 3. Call Location Underground Service 4B hrs. befoie you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � ii <br /> � / rfSvi/.?cT Lii� O�/ T�/E Eo:��c Of iC'09�c✓9� O <br /> / Si/9CL c?E �t''E i.�,�.—.9cLE1� AS /S /F Ti/iS <br /> �•C'�I/Eu/aj/ Gc'��it I•�/!/:lGi/c`J Cc�:�:� 9T Ei�crE' � <br /> DF ST_'r o T Pf�t:•�%�[� � � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF COWDIiIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everell irom any and all claims tor damagds, costs. <br /> expenses, or causes ol action that may arise because of installation <br /> �Y,�L � � /� ,��7/� 7 and maintenance ol the improvemenl or other righPohway use hereto <br /> �� applied lor and (urther agrees to remove same upon notice trom the <br /> Approved for Con ruction Date Cily and to replace public property damaged thereby. <br /> �"�y� _a� �i�f P�, (l Y. ��-Gf !�7�`F/ <br /> FIt�fJl.INSPECTION Date <br /> Approved as Constructed Sic�nature o(Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEP.MIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEAE.4FTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMP�ETION. THIS PLRMIT MA" p <br /> Phone: 259�8815 CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON i' <br /> PROJECT OVER 90 DAYS DURATION. I <br />