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Date � —���d <br />npplitation Fm <br />PUBLIC WORKS PERMIT <br />Print or Type rJnly <br />Madmg Addrr.ss <br />5/�Jn'4' � � - O l� — —__' <br />Apphcant Maihn9 Addrecs City <br />I�ii!i1.�:WO�Mt{�ntm�l• �O�IO. . <br />Bh1U �npl • <br />�onbr. Work� f.e <br />iolM �ee s <br />lrnsAnN fae Pe�� S! � /�'� <br />1)TITI�(NDYI. J �/ <br />ZiP Phunr� <br />Describe P�oposed Work co.�s rn4� r /� ��N�,� rir2�M r�l r /t Oi: � f _ <br />Tn 7�i Si �1 c�,/� L k A i1 al �$ !' Lc I�7 �Ci S/ r%P h,�i3<K �n --- <br />v <br />-f'I..r GL<<� <br />Prolec� Addrese Ol known� <br />_C1:0 "� 7 <br />0 <br />Attach lour (4) copies of plans lor proposed work - Draw to scale anA note the lo�lowing as apuncabie. <br />• Prope�ty Lines <br />• Outiine and dimensions ol all existing and <br />proposetl structures on Ih� lot <br />• ExiSiing a�A proposed utili�ie5 <br />• Crnlerline ot strce�t <br />• Indicale North <br />• Show any proposed grAdmg chanqes <br />• Show measuremrnts <br />PERMIT CONDITIONS <br />1. All calls br inspection shall made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be perlormed i accordance with this permit and current City ol Everett Design and Construction <br />S�andards and Specilication . <br />3. Call �ocation Underground ervice 46 urs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� 11� r'l l� C <br />Approvej lor Constroction <br />�� <br />Approved as Consiructed <br />evemR PUBLICWORKSDEPAPTMENT <br />3200 Cedar Street <br />�I [vereU,WA9B20t <br />� Phone�.259�BB10 <br />'L o <br />r�//6 ��� <br />� <br />� <br />1 — — — — — — <br />� ��r�;� a ,:.��F� <br />�� <br />G,�,"�` <br />ACKNOWLE�GEMENTOFCON <br />W <br />H <br />� <br />� <br />� <br />� <br />a <br />The underslgned owner/applicant herel�y agree5 to hold an7 save harm� <br />less Ihe City ol Evere�l Irom any and all claims lor damages. costs. <br />e�penses, or causes of action ihat may anse becausr o( installafion <br />and maintenance ol the improvement or other ughl�obway usP heieto <br />epplied toi and further aqrees to remove same upon nnfic= Irom the <br />City�d to replace pubhc property damaged thereby <br />� � <br />Sign r. ol Applicant ��a�P <br />V� R AUTHORIZED BV THIS PERMIT MUST BE STARTED NITHIN <br />1 �AYS OF DATE PERMIT !S ISSU�D AND THEREAFT[F IS TO <br />BE DIUGENTLY PURSUED f0 GOMPLFTION. 1HIS PFPMIf Id4Y BE <br />CANCBLL[D BY THE CIiY UPON AWY SiOi'P.4!dL' nF INORH O� T1115 <br />PfiOJGCT OVER AO DAVS DURATIO.'J <br />