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//_.. �7 �f 7 <br /> Date w /'��/ PubLCWorksPe�mi�+ �! /�/ <br /> / <br /> � Application For eiae.oen�.+ <br /> PUBLIC WORKS PERMIT PubTololFooFoe $ 6.� <br /> ��ss nPot Feo va�e S <br /> eelqnco Oue S �as- <br /> Print or Type Only <br /> �A o • c.,a�v �,, ��o � w ,-<< u<--._r�, 1 u..ef�- c..>a 5��9 z.�a-�3��. <br /> Owner Mailing Address City Zip Phone <br /> ���.-� - <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �-'/ C�C� / /����> ��C� O <</ � �i/K:�U� _ <br /> �� ��d�� � <br /> �,/�,� W <br /> Project Address(it known) E_�QT /� -/L,�� ��C�� �� �� � <br /> � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note ihe following as applicable: S�7c��� � <br /> • Property Lines . • Centerline of street .�/�e;•��7 � <br /> • Outline and dimensions of all existing and • Indicate North ( <br /> proposed stiuctures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection sha�l be msde 24 hrs in advance•phone 259•881 5. � <br /> 2. All work shall be pertormed in acccrdance with this permit and current Ciry of E�-aretl Design and Construction <br /> Standards and Specificationa <br /> 3. Cali Location Underground Se���ice 48 hrs. before you dig.TOLL FREE NLMBER 1•800•424•5555. � <br /> y ..�,� ,�,� o,���- <br /> �� �T��`—� i� c� ���T C'.���N„ O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF(:ONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> — less the City ot Everett trom any and all claims for damages, costs, <br /> /% expenses, or causes of action lhat may arise because ol installation <br /> �` G� and maintenance of the improvement or other righ4ohway use hereto <br /> �) �� �� applied for and furiher agrees to remove same upon notice from the <br /> Appr�/yfor o ructi Date City and to replace public property damaged thereby. <br /> C ____,�/ //�/���.��� %�Y C -�7 /� <br /> FI�IA SPECTION Date ��++ �'J'�-�� ��� � �7 <br /> Approved as Constructed Signature of Applicant ` � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN <br /> � 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DiLIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8815 CANCELLED BYTHE C��fY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 D�YS DURATION. <br />