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Date�'1L//S <br /> i�— c <br /> PupL[lYorFS Pprmp a �J�� <br /> Application Fo� e�nq oe�� . <br /> PUBLIC WORKS PERMI�' <br /> Pulnic\Yorhs Fee -- <br /> . iolal Fpe $ <br /> L'f�//B.d� ---� <br /> Print or Type Onl DD7�3� 1e55A001 FnpPa�y s_�_ <br /> Y Oalan[r Our $ �Q ��— <br /> : —� <br /> �0 Y� .�Pi�n �,�/ a � Y����Q �j}y-/J/ � �;9- 9�9_ 9a77 <br /> wnei �—�l.�w i�_rL�/ 4! C/ i� .�r/s�d � . �zm� <br /> �\+,a,in�i ArlJress <br /> � ��'��' 7_�n <br /> r r f � ' ' �,����s���so <br /> =�' � ��ri/ �� ��f�/� �--���_ <br /> AP �� ant Pda��nv; � �------__��u�� � � <br /> � hdtlrPSS C�f`, <br /> 1I ,, zi� Phone <br /> Describe Proposed Work � ��// 0 1/ � , , , <br /> ✓.{�K/ ` <br /> --�-- �is�i.,�e�/Yt�ewR /s qfavcJ <br /> _ -- �. <br /> _ __------ W <br /> PrOject Address(d known; <br /> -E/`1��i ly�__�_--�,�i-� <br /> AttaCh lour(4) eoP�eS of plans toi propused wor� � Lr��c to >c,ii„an,y nolr•tn,a '�qur�mg ns anUhcable: � <br /> � Property Lines - <br /> • Oulline and dimensions ol all exishng anq � Cen�erhne nf stree� � <br /> proposed slructures on the loi • Indi�ale �lorth � <br /> • Existing and �roposed utilities � ���oa�any rrenosed�ratlmg r.hanges <br /> • Show measurements <br /> DO NO7 WRITE 6EL01N THIS LINE m <br /> PERMIT CON�ITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shell be performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specificalions. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-8pp•QQq.5555. <br /> � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOl1�LEDGEMENT OF CONDITIONS <br /> __ Thc undarvqned owneUapplicant hereby agrees to holtl and save harm� <br /> I ��'Si ����' ���Y o� Everett frorh any and all claims for tlamoges. co;ts. <br /> ��� � exPensrs. or �auses of action ihat may ans� because of msta!lation <br /> ,l� �Ins ! and mainten�nr.e ot the nnprovement or other right�ol-way use heie�o <br /> APproved f on5irucL n /� pi� � anni��nd lor and �uriher agrees to remove same upon notice from Ihe <br /> c� � � ' i. <br /> � Ch� rd to rePlac.�ouUhc property dam ged thereby. <br /> � j I � � �� <br /> FI IN CTION' / �� <br /> Approved as Constructed ��« I <br /> y. Siyna me of pplicant p �� <br /> PUBLIC WORKSDEPARTMENT INORK AU ORIZED BY iHIS PE IT MUST BE ,"i7ARTED WITHIN <br /> 3200CedarStreet �AO DAY F DATE PERMIT IS ,UED AND THEREAFTER IS TO <br /> Evr.rett,WA 98201 BE DILIGE iLl' PURSUED TO PLETION. THIS PERMIT t.AqY gE <br /> Phone;259�8810 CANCELLED BY THE GTY UPO NY STOPPAGE OF WORK ON THIS <br /> i PROJECT OVER 90 DAYS DURATION. <br />