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r..__.. _ - --- - - <br /> Date_���� P�o���wo,ka�a�m�„ �� � _ <br /> Applicaticn For eiaa oea�.. <br /> PUBLI(: WORKS PERMIT PuLTotalFeereB s <br /> �ess nooi.Fee ve�e S <br /> ��' .� <br /> �alenceDue S <br /> Print or Type Only <br /> �c���.�- 3" Pn.il' � ,l.W�e... $olr � Uir„�R;A.;c, lJr ��:rcti GJ.� 95�3 339-8od) <br /> Owner Mailinq Address City 2ip Phone <br /> /� ,.f_- s�(.—V. R�U v L . <br /> rGLJ�� !y\r 'V'�— � ' <br /> Applicanl Mailing Address City Zip Phone <br /> i� l� I .1 <br /> DescribePioPoseAWork /^S'�1` �Z ��_�� 5�7���f I'z�i � T�^.�/c� c7�� ccT7 ir(���-/ � O� <br /> WM t ra«O� �o�., n.� �r•'r' WCST .`�/� ,T P''�z/�}:, . GJY._.(� //!cL <br /> � �...-"4 T�-,^[� e� .."� Gan.l-b . !l I�e `�s lJ�,,,"� ti �ti[.,.Jn P' .a-"fG /rl . <br /> �� W <br /> ProjectAddress�ilknown) SOb £• v ��w fZ��Ra.� L�.-i�°- � <br /> Attach Wur(4)copies of plans for proposed work• Draw to scale and no�e tha lollowing as applicable: � <br /> • Property Lines • Centerline ot sirect � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on tM1e lol • Show any proposed gradmg changes <br /> • Existing and proposed utilities • Show measuremenls I <br /> � <br /> DC NOT WRITE BELOW THIS LINE �� <br /> PERMIT COND�TIONS <br /> 1.All ca�ls for inspection shall be made 24 hrs.in acs ance-phone 259•8810. �� <br /> 2.All work shall be pedormed in accordance with thi:,permit and current Ciry ot Everelt Design and Construction <br /> Standerds end Specifications. <br /> 3.Cail Location Underground 3ervice 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> `� <br /> � <br /> 0 <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The�.mtlersigned owner/applicant hereby agrees to hold and save hann� <br /> - less the City ol Everett Irom any antl all claims fo� damages, cos's. <br /> //""�� /� /� C ezpenses, or causes ot action Ihat may arise because of installation <br /> � �I 1/ I ��o(,?J 17 7 and mamtenance of �he improvemenl or other righFo(�way use hereto <br /> `� � �-��� 'T""^ �_�` applied lo� and funher agrees to remove same upon nolice Irom ihe <br /> Approved for Cons}ruc ion Date City and to replace public properiy damaged ihereby. <br /> ��%l'�� 3 - '� -`� 3 �,( a ,l � C��,�G�! ��_ 7'y� <br /> FINAL INS�EGTION Date �� <br /> Aaproved as Constructed Signature ol Applicant Date <br /> PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY TIiIS f'ERMIT MUST BE STARTED WITHIN <br /> ��� 780 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> � 3200CeCarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> ���� Everett,WA 98201 <br /> CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DP.YS DURATION. <br />