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Date/c `�%� � • a�oi��wo�k�rp�,�m��= /S3 �O <br /> eiaa.o�ai.+0— <br /> Applicalion For <br /> PUBLIC WORK� PERMIT '°°,o,aFceFco 5 <br /> �ess noPi.Fee vam 5 <br /> eaianceDuo 5 <br /> Print or Type Only <br /> � <br /> ,//�-.�/i�,��— C� �.¢��/' ?��O C�PC9nl�Al, �f=�c'�Tl��i3 �� ���� <br /> Owner A.vling Address City Zip Phone <br /> �� � Fhone <br /> Applic nt Mailing Address City ziP <br /> Describe Proposed WorkH�� �YJ`'`�4�r%= — � 1 �r � • ������ <br /> /n /7�"/.� %,� � � � � ,1> L- % �Sff �4. <br /> , -. ./C/�'�_� <br /> �.E'/��`�!;¢��',� /fnG�sr-_ /C �,4�'�T o.� C�-.p �� ., - � /� - r� <br /> T� i��-�� 'L-0 � � �� � � � � . , _ ;,� _ r �/oc , W <br /> Proiect Address(il known) ��l��- -•--{� `s�����"�� J ~ <br /> �� <br /> Attach lour(4) copies ol plans for proposed work� Oraw to cale and note the lollowin9 as applicable: � <br /> • Froperty Lin?s • Centerline of street <br /> • Gutline and d�,mensions of all existing and • Indicate Norlh <br /> proposed sirudares on the lot • Show any D:oposed 9rading changes <br /> • Existing and proposed ulililies • Show measu�ements M <br /> W <br /> DO NUT WRITE BELOVJ THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> ?. All work shall be perlormed in accordance with this permil and current City ol Everett Dr.sign and Construction <br /> Slandards and Specifications. <br /> 3. Call Location Underground Service aA hrs before you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> � O <br /> ��L�7 �( > % � �,�',�.;� �E�'�'.'�% ic�[<�,� c�,�°�1 �' � <br /> ��� /�� ����� <br /> v <br /> �i.11� � J '� � � <br /> O <br /> a <br /> ACkf70�1�LE�GEMENT OF CONDITIONS <br /> ihe unde�signed o�+����!�appiieaM hereby agrees to hold and save harm- <br /> — Iess the City of Everait Irom any and all claims lor damages, cosls, <br /> expenses. or causes of action that may arise because ol installation <br /> and maintenance o1 Ihe imp�ovement or other ri�jht�ol-way use hereto <br /> applied �or ,�nd fur�her a9rees �o remove same upon nohce from �he <br /> Approved for Construction Date �ity ond to icplace p�i�lic properry dama9ed ,hereUy. <br /> FWAL INSPECTION �`�1e Date <br /> Approved as Conshucled Signa�wc ai Applicant <br /> WORK AUTHORIZED DY THIS PERMIT ��fUST BE STARTED WITHIN <br /> everelt PUBLIC WORKS OEPARTMENT 1g0 DAYS OF DATF PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> � 3200 Cedar Slreel BE DIUGENTL� PURSUED TO COMPLETION THIS PERMIT MAY BE <br /> Everetl.WA 98201 CANCEILED BY THE:ITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-6815 pROJECT OVER 90 DAYS DURATION. <br />