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; . . � -- <br /> Date� ��t,,,�wo,�aPa�m,� B6— Z55 <br /> ApD���ation For eiac.o�o�.•��� <br /> PUBLIC WORKS PERIVIIT P���,�W�-�^F�a <br /> Tote1 Gee s <br /> Leet�ppl.Fee PeiC S <br /> Print or Type Only es�a��eo�e s �O�o <br /> •—�� (1 I,�^ ,[/ � . � <br /> � /�Do�'�G rY ( C'��w lV�4sC �`��/ C'� . C `�rn r�o?s c�-CY 95 <br /> wner Mading Address City � Z�p Phone <br /> � <br /> ��l <br /> ,.t ��� <br /> Applicant �lailing Address Gty Zip Phone <br /> Describe Proposed Work � '�u-.� ��/` <br /> ProiectAddress(ilknown) `-���6 � -���`4 �� A�E- � <br /> Atlach low(4)coFies ol plans for proposed work- Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline of sireet /w <br /> • Outline and dimensions ol all existing�nd • Indicate North V� <br /> proposed structures on�he bt • Show any proposed gratling changes <br /> • Existing and proposed utilities • Show measurem=nis � <br /> p0 NOT WRIT[ BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls lor inspection sh�ll be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permlt and current Ciry of Everetl Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Unde�ground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•4:[4•5555. � <br /> 7`n /tE"/n�vE �,`' if'Efj',deE SdEw/J4C f�T NEcc.J O <br /> �.ei/�EGfI.�/ f�L'L'ESS , iPEP�AGE Ge/iTH ln �� !y.lC.� <br /> S/DEA�9G.0 � <br /> .� �Qti�p/� ;t �� <br /> .PE.�,9�'E SiDEGl.9c.r 7�0 1�s✓E ,/� <br /> /Ud�T� N� Su�irfs o/' 7i.E .vE�✓ D._��vEw.9� AC�FSr� V, <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF COMDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City ol Everett Irom any and all claims for damages. cosls. <br /> %� � /Jp / expenses, or causes of action that may arise because of installation <br /> '-�j}J��l.f� /�:'Or,/�— .S Z �� and maintenance ot ihe improvement or other rigM�of�waY use hereto <br /> Approved lor Construction � Date applied for and lurther agrees to remove same upon notice Irom 11e <br /> City and to replace public property damaged thereby. <br /> �f-� <br /> %]�;.� _ �.-,� �-�� ��'��.�� � �--���.� <br /> FIN T N Date <br /> Approved as Constructed Signature ol Applica t ate <br /> evereU PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireei 780 DAYS OF OATE PERId1T IS ISSUED AND THEREAFTER IS TO <br /> EverelL WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. 7HIS PERMIT hlnv 13[ <br /> Phone: 25g-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7��i5 <br /> PROJECT OVER 90 DAYS DURATION. <br />