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� <br /> Date�1��� p 6'S-�9 <br /> PuOl�t Works Panidl/+ '/ <br /> Bidq.Deot.r p Sl�u7�� <br /> AF plic.�ion For <br />� PUBLI� W��14�� P'ERM17 °°°�`°,°`",F`� <br /> Talal Feu s <br /> L�fssAOP�fee Paitl S <br /> Balance Due S '��'� <br /> F�int or Type Only J�3 r�{7 <br /> A <br /> C' h�l21 I i C.nr�st�-�- ��L.��C_ I`I2L� 4tti� 1,� ��^ex�t� `�'�ZO3 �S'�-9412_ <br /> Owner Mailing Address City Zip Phone <br /> ch�IQJIi� r„n�rr.lc�7c�'� TnG �`i2b 4`l��^ W Gv-er-f�fi' q �20=_ 355 -�}IZ _ <br /> Applicant Mailing Address City Zip Phone � <br /> c 911U�� 'F"aWll i� V'-2SIC� Pt1c�__ ;'^ <br /> Describr. Froposed Work ����� � COY\...�7'UC�1�QY1 � I • <br /> i � T <br /> W " �' <br /> i, '^ _ <br /> m <br />' /�— E. /?94i('/C </y� c' � o <br />' Project Address(il known) - C � <br /> m o <br /> t-� <br /> II Attach four(4) copies of plans for proposed work• Draw to sc�de and note lhe following as applicable: � � � <br /> • Property Lines • Centerline of street � m <br />{ • Indicale Norih = "� <br /> • Outline and dimensions of all existing and <br /> proposed structures on lhe lo� • Show any proposed gradinc�changes m �• <br /> • Existing and proposed utilities • Show measurements � '� '' <br /> p � <br /> r � <br /> DO NOT WRITE BELOW THIS LINE � � N <br /> � <br /> PER�IIT CONDITIONS '� <br /> oz <br /> 1. All calls lor inspection shall be made 24 hra in advance- phone 259•881 5. � T� D <br /> 2. All work shall be performed in accordance with this permit and current Cily of Everett Desigr.and Conshudion .� m <br /> Standards and Specifications. _ � <br /> 3. Call Location Underground Service 4B hrs.before ycu diq.TOLL FREE NUMBER 1-800•424•$555. � o v+ I <br /> r ,�.f/STAGL. /� �� CO/1/C.�'ETE ���� CUG(/E.P.T �m � <br /> O � � <br /> A r B�G„�,r,�,,v<.- o� o�.�E,��y.. !, <br /> � � <br /> —� r <br /> • m i <br /> � n i <br /> z <br /> r/ � <br /> x <br /> a <br /> z <br /> �/� � <br /> s <br /> ., i <br /> 1� N <br /> z <br /> 0 <br /> � <br /> .-. <br /> � <br /> m <br /> ACI(NOWLEDGEMeNT OF CONDITIONS <br /> The undersigned ownur/applicanl hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims lor damages, costs, � <br /> ezpenses, or causes of action that may arise bewuse of installation <br /> � / 17 /� -o � r and maintenance ul thc improvement or other righl-ol-way use hereto <br /> /J'i ,G�G>ai>�— G �� �=� spplied lor and lurlher agrees to remove same upon notice Irom the <br /> Appro— v�Consiruction Date p�ty to replace public property damaqed Ihereby. <br /> 1 � <br /> ..ti �S � _L� <br /> FINAL W EC Date Date <br /> Approved as ConsVucled SignaWre o ppl an <br /> WORK AU HO IZ BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcrr.t[ PUBLIC WORKS DEPARTMEh 180 DAYS DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet - BE OILIGENTLY PURSUED 70 CONPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CFNCELLED BY THE CITY UPON ANY STCIPPAGE OF WORI<ON THIS <br /> Phone: 259�8815 pROJECT OVER 90 DAYS DURATION. <br /> r <br /> ! . <br /> 1 _ <br />