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� sy s � <br /> / Pu�uc W��ka Peemi�� � // <br /> Cat / e�ao oeoi •�'S/�� � <br /> Applicetion Foi <br /> PUBLIC WORKS PERMIT PubTo�Fea��� S � � � <br /> �essnoo�Fe� aa�a S <br /> — <br /> s '��o, o 0 <br /> Balence Due <br /> Print or Type Only p g / �7 <br /> � � � , 0 . T� S,r"�� ^ 5." - ���C� <br /> A7., .YC ..i /�..,._/�. . .,�- Y.'9/f.,. —..... ^Phone �� <br /> N,� � _ Mailing Address ���Y Z�p <br /> /k y.p,-� ,f:... �Tj , —,.� _ <br /> i ,�"� /d / �J /✓,1S/�,..... �i;.._., G�..«..T' S.r.�� / rS�-/ic.. f_- <br /> � Applicent Mailing Address ! City Zip Phone <br /> � ��. � /.. ./..�».: �- �� �� -� - <br /> Describe Proposed Work �'��- , <br /> / <br /> - W <br /> Projact Address�il known) <br /> 9 is -' -�',.(J 1�,�, ... s F_ �- .,._ .�_ /% r <br /> � <br /> Attach four(4)copies ol plans tor proposed work• Draw lo scale and no�e ihe following as applicahle: � <br /> • Proper�y Lines • Centerline of slreet <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed sVuctures en the�ol • :how any proposed gradme�changes <br /> • Ezisting and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRIT� 9ELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls lor inspeclion shall be mad�2a hrs. �n advance� phone 259-881 5. Z <br /> 2. All viork shall bo performed in acwrdance with this permil and current Ciry ol Everett Design and Construction C <br /> Slandards and Specilications. � F= <br /> 3. Call Location Underground Service 4tl hrs. before you d��,.TOLL FREE NU�9BER 1-800•424•5555. � <br /> O <br /> �� y � <br /> N H � <br /> d � <br /> O M.� � <br /> � o � <br /> � <br /> � ' <br /> r. <br /> ACKNOWLEDGEMEIJTOFCONDITIONS _ .b <br /> :� <br /> The undersigned ownedapplicant hereby agrees to Yold and save harm� S <br /> less ihe Cily of Everett Irom any and all claims tor damages, cosls, <br /> � expenses, or wuses of action that may arise because ol installation = <br /> � �� i -�y� / -� _/C _�� and maintenance of �he improvement or o!her righPof�wsy use hereto .� <br /> - applied lor and lurther agrees to �amove same u�on notice �rom Ihe � . <br /> Apptoved fo onstruction Date City and lo replace public property Jamaged thereby. <br /> i� � ' . <br /> �.� � ! �--3 �� �'�; �' "'� � � y, � �. <br /> �l ��'�.'�' � l�V� �� � �' �G-r l � �i�`'S' � <br /> � Datc ' .��, _:.,— .� , <br /> FINAL NSPECTION �:ignature ot Applicant Date � , <br /> Approvcd as Construc�ed � . ' <br /> WORK AUTHORIZED BY THIS PEHMIT MUST BE STARTED WITHIN <br /> ���everet[ PUBLIC N'ORKS DEPARTMENT 1B0 DAl'S OF DATE PERMIT t5 ISSUED AND THEREA�TER IS TU <br /> � 320G CeCer Sireet BE DILIG[NTLY FURSUEU TO COMPLETION. THIS PERM:T MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT GVER 50 DAYS DUHATION. <br />