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Date7'S '� vum;cwor��cermu• " / a �� _'— <br /> Applita�ion For Blao Depl.• g /� a _ <br /> PUBLIG WORKS P�ERMIT P��Tot�FeeFee 5�, ,,� <br /> ILeF:RpO� �ae PaiE � <br /> eal�nce Oue S y�� p� <br /> Print or Type Only ',07�0 <br /> / <br /> f7�[c'S f�iJ�FS T� �a4• S[" �i'E,FE.�7"��/« c�'R% CL��XEr/ j,fzcx/ 3SS=�1k51— <br /> Owner Mailing Address City 2ip Phone <br /> �GU�1/c�Z <br /> Applicant Mailing��ldress City Zip Phone <br /> � e/ ri / <br /> Doscribe Proposed Wor�rG91!!!�-` �? CG�—�-�L--L�L��� � CL'�lC��'Cva1�__ <br /> W <br /> Pro�ect Address(il known) � � � ��2 Ph P C'Va 5. Lu, _ Lo'{' #9� � <br /> Attach lour(4)copies ol plans lor propoSeA work-Draw lo scale and note the lollowing as applicable�. v <br /> • Property Lines • Conterline ot slreet ♦A <br /> • Outline and dimensions of all rzisting and • Indicate North V� <br /> proposed sirucWres on the lol • Show any preposetl 9rading changes <br /> • Existing and proposed utili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CGNDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current Gity ot °verett Uesign and Conslruaion <br /> Standartls and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLI FREE NUMBEA 1•800•424•5555. � �. <br /> i <br /> Q <br /> �w H � <br /> a � <br /> y/ ti � <br /> � C <br /> � � C <br /> t <br /> � � F <br /> � ' <br /> � '_ <br /> � <br /> � ; <br /> y . <br /> ACHNOWLEDGEMENT pF CONDIL��N: <br /> , F <br /> Thc untlersigned owner/zpplicant heieby agrees lo hold and save harm� • �' <br /> — — Icss ihe Ci1y ol Everett Irom any and all claims lor tlamages, costs, <br /> ___ _. expenses, or CaUseS Ot aC�ion Iha� may 0ri5B SeCauSe ol in5talla�ion .� K; <br /> ��,�-���/�' / J_��, � and maintenance of Ihe imp�ovemem or olher righPol�way use herelo � �� <br /> / ``""'_'__ <br /> Appro d I s ucGon ate af�p and lurther agrees to remo:e same upon nolice Irom the <br /> -'City and lo eplace publi property damaged Ihereby. `� , <br /> 0 �( � , / �/ � . <br /> ,� / <br /> � . <br /> FINA WSPECTIQN Date `� �%�� � /" ` / �� � � <br /> Approved as Constructed Sign6T[�re-b ApplicaN Date � � <br /> everett PUBLIC WORKS EPARTMENT WORK AUTHORIZED BY 7HIS PERMIT MUST BE STARTED WITHIN , <br /> � 3200 Cedar Slreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERM1IIT MAY BE <br /> Phcne: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK GN THIS <br /> PROJECT OV[B 50 DAYS DURATION. <br />