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� <br /> , � R/(� � v� <br /> , PUUI¢�YO�k�Permit� �--���—- <br /> DateS�a4 �o�l��-- <br /> 6ia0 Deo� � � <br /> Applicalion For ,___ <br /> PUBLIC WORKS PERMIT °°°"`"'°"`"Q <br /> ,o„�F:� s_ <br /> i._.>s nnoi �«..aa�o S <br /> �1��— <br /> e,.....�.�,�.�. S_. � <br /> Print or Type Only <br /> s- 7K s.t B rl, ,,� NGNi 4aaas � ��- 9�Y,F <br /> wner <br /> Maihng Address G y LP Phone <br /> pplir,ant <br /> Mailing Address Clty Z�P Phone <br /> f- <br /> Descnbe ?ropos�tl Work _ � Pu� -� � � <br /> — W <br /> Project Adaress lil known) _ <br /> �oo�- - F � H <br /> � <br /> Attach lour(4)�opies ot plans tor proGosed wo�k- Drow to 5^.ale anC nnte Ihe to��owing as applicable�. � <br /> • Prope�ty Lines • Genterline of street <br /> • Indicate Norfh <br /> • Ou+l�ne and dimensions ol all exis�ing and � Show an/proposed grading changes <br /> proposed str•,�ctures on the lot � ghow measuremeMs M <br /> � E�iSiir�y e�:i Proposed utilili�s W <br /> DO NOT Wf71TE BELOW THIS LINL O <br /> PERMIT CONDITIONS � <br /> 1.nll calls for inspection shall 5e made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pertormad�n ascordance with this permit and wrrent City ot Everetl Design and Construdien <br /> Standards end Specifications. � <br /> 3.Call Location Underground:iervice 48 hrs.before you dig.TOLL FREE NUMBER�•$OO•42'1•5555. <br /> r � <br /> �4' H <br /> ; �i <br /> r O <br /> � a <br /> ACKNOWLc�:�GEMENI OF CONDITIONS <br /> The unde�signed nwneya ^!.caN hereby aqrees lo hold and save harm- <br /> rn� less ihe City of Everett � '�, any and all claims for demages. costs, <br /> e>.penses, or c�uses et acr �n that may arise because ot inslallation <br /> /J � � �� ���� and maintennn�,;e ol the imFrovement or other righPot-way use hereto <br /> �; ,�Q/ /jj!—c77� i_ applied for and furto.:r agrces to rnmove same upon notice Irom �he <br /> ApproveA for Cop51�uction Date City and to replace puMic proper damaged thereby. <br /> ,��,Gf:/�l�� �� 7 <br /> "�""/ /o-.:- �� <br /> fl!�nL INSPECTION Date le <br /> Signature ol pplicant <br /> Approvetl as ConsVucted <br /> WORK AUTHORIZfD BY 1HIS PERMIT MUST BE STAiiTED WITHI <br /> everett PUBLICWORKSDEPARTMENT �g0 DAYS OP DATE PERMIT IS ISSUED AND THEREAFTEH IS ?O <br /> � 32UOi.etlarSt�eet BE DILIGENTLY PURSUED TO COMPIETIOtJ. THIS PERMIT MAV BE <br /> Evr.ret�,Wq gg201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phane:259-BBtO PRGJECT OVER 90 DPVS DURATION. <br />