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��y� <br /> D.`tl x �• <br /> YHy <br /> t � ��� � QQ <br /> 1~-]�i-�i Date_.�LLt11.� I '�� r-"' vuo�m Wo�xe ve� � ��/�/�s��^--/�L'f1� <br /> 1!. y� 9in9 Oea�.• �JQ��ll`J-1-.. <br /> Appli[otien For <br /> �" � PUBLIC WORKS PERMIT °°°°°w°°°°°° -- <br /> V1 H ioiaiFee 5 _ <br /> � lesaRnD�iee Paia 5 <br /> o eaia�crDue S <br /> p H d Pnnt or Type Only — <br /> ��g <br /> �Y (] <br /> � y� �1�lil I �� _►�a( l�r� � �'�_r�� q�� .� -�L�1� <br /> Owner Malhng Adtlress Cny Lp Phone <br /> 8 d y �,�,r�► u � �,va�ia—1�-�l l �-!�/�o `t���i �=,1�' ' �T(�5��2�� <br /> C Applicant~ MailingAddress ty Zip Phone <br /> �" � T�, �Q�(� T _—^ ��''y'/7 (� I 1 <br /> y O fyi� DeSCribc PropOsed Work 1 F ,v `�`�� ' 1� • � '` ��` '---�� � ��`�s—T— <br /> I��l � <br /> Prolect Address�il known� V� � <br /> Attach four(4)�opies of plans for proposrd work-DraH fo sWle antl note Ihe following as applicable: � <br /> • Property Lines • Centedine ot sireel /A <br /> • Outline and dlmensions of all ezisting and • Ind�cate North V� <br /> proposetl siructures on Ihe lot • Show any proposed grading changes <br /> • E�isting and prpposed ulildies • Show measuremen�s � <br /> DO NOT WRITE BELOW THIS LINE O <br /> '�1 PERMIT C7NDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with Ihis permit and curren�Ciry of Everett Design and Constmdion <br /> '�' Standards and Specifications. <br /> ?.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•b555. � <br /> ; j l�� �-r ���� i�.D 0 <br /> � �� ('4�1 `-�-` �" <br /> � . _ � - Y� J � <br /> ►—� � <br /> - a <br /> �_e <br /> ACKNOWLEDGEMENT OF CONDI710NS <br /> ' The undersigned owner/applicant hereby agrees to hold and save harm- <br /> ' less Ihe City ol Everett Irom any and all claims for damages. costs. <br /> expenses, or causes ol actio� thal may arise because o� installation <br /> antl malntenance ol the improvement or olher nght-ol�way use hereto <br /> " � applied for and lurther agrees Io remove same upon notice Irom the <br /> Approved for Construclion Date Ci1y and lo renlace public properly damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consliucled Signatme ol Applicant Dale <br /> WORVc AUTHORIZED BY THIS PE(iMIT MUST BE STARTED 6VITHIN <br /> evcrcll PUBLIC WORKSDEPARTMENT 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarStreet gE DILIGGNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORN ON?HIS <br /> Phonc 259-8810 PROJ[CT OVEFl 90 DAYS DURATION. <br />