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�— T �-9 <br /> i <br />� <br /> Date'S�G`��� � � <br /> PUCIit Workf Permi • <br /> Application For eiao.o�o�., /J- � ���.� , <br /> --� <br /> PUBLIC WORKS PERMIT ��°TO1eFa;Fep S <br /> �ess aon�Fea aa�e S <br /> Print or Type Only ee�,��e o�, S <br /> U� ���PS%�'ie ���?.S mPrpce �� 5�a� �sa - G i�� <br /> wner Mailing Adclress City Zip Phone <br /> _ \�i�m e� � <br /> AppNcant Mailing Address City Zip Phone � � <br /> Describe ProposeC nWork �CK3. �AC1,�"D�M � . /1 ,P�)O/p�_��_D�eq�/� •• <br /> J-f� �� <br /> M H <br /> �] '+1 <br /> W ~ � <br /> � <br /> Pro)ect Address(if known) � � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � y <br /> • Property Lines • Centerline of street � d <br /> � Oul�ine and dimensions of all existing and • Indicate North � <br /> propos=A structures on the lol • Show any proposed grading chenges �„i <br /> • Eaisting and proposed ufililies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE � M <br /> O N <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shail be made 24 hrs. in advance•phone 259•881 5. � ,�,� <br /> 2. A�I wo�k shall be pertormed in accordance with this�per t and current City of Everett Design and Construction � <br /> Standerds and Specifications. y_� <br /> 3. Call Location Underground Service 48 hrs. bef�r�y�u dig.TOLL FREE NUMBER 1•SOO•424•5555. y <br /> ►7 V � <br /> ��` \, � <br /> Q w n�`� ,� O y <br /> v • � <br /> o�► Q � F- <br /> � � � � � <br /> � �� .$� � <br /> Q , o � <br /> � ,a. a N <br /> � <br /> Mn <br /> M <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownc�r/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damayes, costs, <br /> expenses, or causes of action that may arise because of Installation <br /> and maiNenence of the improvement or other right-ohway use herelo <br /> applied br and lurther a rees to remove same u on notice Irom the <br /> Approved for Construction Date City and to reploce public9property damaged thereby. <br /> FINAL INSPECTION Dale <br /> Apprmed as Consiructed Signa�ure of Applicant <br /> Date , <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-BB75 CpNCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> � <br /> � � <br /> .�. - _ _ - � � _ � _ ___ � 1 � <br />