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._ . _ ,-, ,..., <br /> Date �n� PuDiitWarMaPermit+ <br /> Application For Oltlg.Depl.• �� ��� <br /> PUBLIC WORKS PERMIT PubTolelFeoFee s � <br /> Less Apo�foc Paia $ <br /> Ba�nnco Due S <br /> Print or Type Only <br /> �ya �T �;• ^ l�.� I J SS 7`G /�✓e .�/.E Sn o%t ,vfai c 1ti Cl�{'.�2 4'rl �?�!—1,f'9 � <br /> Owner Mailing Address City LP Phone <br /> Applicant Mailing Adtlress City 2ip Phone <br /> Describe Proposed Work �h �V e.X'� � ��� �-5-�—�' C617 U n�'�� <br /> L�'i�e�.0 <br /> W <br /> Project Address(if known) � <br /> Attach four(4)copies ol pla�s lor proposed work• Draw to sca�e and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the tot . • Show any proposed gratling changes <br /> • Existing and proposed utilities � � Show measuremenls M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspectlon shell be made 24 hrs in advance• phone 259•881 5. � <br /> 2. All work shali be performed in accordance with this permit and current City of Everett Design and Constru on <br /> Standards and Specitications. <br /> � 3. Call Location Underground Service 48 hrs.6elore you dig.TOLL FREE NUMBER 1•80U•4 55. � <br /> I �mautir o� «e�c Dcu.� To TN%F.e.o.c- A�i'LiGN�/7 C,U9.�(�in/rs O <br /> �y��,r � A,ud zmi�ycT To �'Uf'LEX — BECqvtE � <br /> pf QNLf/ OA/E ExT,QA jkv£cCi.vG U�t//T �T Etiou!"y '�A"�D <br /> 11�OU�TCoS9,F.Go.Jl' IinP•toll6mEnlT Ta `oR CA✓l�E.t.voi✓ TO � <br /> TRt/PLEX PE,C �LAtiW/�t/b O <br /> Gz.Pt.fEO S��E.✓9c.t fJT Tis�is TiinE. DE.a'T. <br /> �Pr°�ic.l.vT Pt,9,us Ta Ca+/vE'.eT Tv TiziotEX i�/ T�'E �i <br /> ��Tv�E, f/E �t.�^iS .�xD AT Tis�yr TiinE h�E <br /> /-a/oUGD BE ,f'E'qui.�'o To .PE,yHLE So�E � <br /> r�/E S/OE6t/9LiC' ON P��✓E ST, �SEE 91r9�+f'ED�CKNOWLEDGEMENT OF CONDITIONS <br /> E The undersigned�wner/applicant hereby agrees to hold and save harm• <br /> �7., yis i�E. �''� less the Ciry of Everett Irom anY and all claims for damages. costs. <br /> y����C expenses, or causes ot action that may arise because ol installatio� <br /> and maintenance o1 the improvement or other right•of•way use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> Approved for Construction Date City and lo replace public property damaged thereby. <br /> FINAL INSPECTION Da'e <br /> Approved as Conslructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED `NITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />