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oate�c�g ��o,�,�o„s Pe,m 8` 32� <br /> BidA DeD� � � <br /> Application For <br /> PUBLIC WORKS PERMIT '°�ro„F:a`°° s <br /> LecsAoa� FcePaia S—�..� � <br /> i W <br /> 001anc0 Due s ���� _ <br /> Print or Type Only <br /> �t�Pa�1F`3(l � � i��� � S I�IIr l'�Y� S�./�Tr1� <br /> pW�e� ��MailingAddress City Zip Phone �/ <br /> (C <br /> "�'"�4m� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work r .�'w�) �1 /[ � <br /> W <br /> Proiect Address lil known) 25/S �.BG .� — �»L'�!///f� Al�� � <br /> Attach lour(4)copies of pians for proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> • Properry Lines • Centerline of streEt � <br /> • Outline and diinensions o1 all ezisting and • Indicate North <br /> proposed structures on the Iot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremen�s � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259-881 O. � <br /> 2.All work shell be pedormed in accerdance with this permit and current Ciry of Everett Desi�7n and Cona;uction <br /> Standarda and Specilications. <br /> 3.Call Location Underground Service 48 hrs.t efore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> 7, /`�u+-5� � �`GC!/Q�y '-Vu"C�. .�/(�G1 � �'t�� O <br /> � !r�/' /�h.L41.1!l�ClT�./ G�, a r Oj �CNQ � /Qn2;� <br /> oz•e„� `/ "� ir+i+��v.v�c�� /.k a.eU+�.� Cvv�a-li. � <br /> ,f N <br /> O <br /> a <br /> �CKNOWLHOG[MENT OF COIJDITIONS <br /> _ �, J The undere��gned owne�,apDlicant hereby agrees to hold and save harm� <br /> less Ihe City of Everett Lom any and all claims for damages, costs, <br /> �'������ ��/ /DD exPenses. or causes ol �ction lhal maY arlse hecause of installation <br /> and maintenance of the ,nprovement or other right�ot�way use here�o <br /> s appf or and ��riher agrees to remove same upon notice irom the <br /> Approved lor onshuction a�e Ci an _ . public property damaged ihereby. <br /> � —z:a-v�— /01 %6-�� <br /> Ri Al INSPECTION Date � �� <br /> Appr�.eu a�Constructed Sg a re of hcan D�te <br /> l'JOFK AUTHORiZflD V THIS PERMIT UST BE S7ARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32.00edarStreet BE DII_tG[NTLY PURSUED 70 COMPIETION. THI° PERMIT MAV BC <br /> Everett,V:A39201 CANCELLED BV THE CITY UPO^!ANY STOPPAP.�OF WORK ON THIS <br /> Phone:259�P810 PROJECT OVER 90 DAYS DURA i ION. <br />