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DBte� P�erc won.v.,m��. <br /> AppIiCH�ion For 0149 D�ot• 33r4� <br /> PUBLIC WORKS PERMIY ���KW�^�F� - <br /> io1�IF�s � <br /> L�n ApD�F�e PUE � <br /> Print or Type Only e.�,��.o�. t <br /> �� P�Jc_A� 1�1� �oGbe�e ��c/�e7'� a� ��s,�c�i � s`'i -3D3 (o <br /> Owner Meiling Address City Zip � Phone <br /> e L(i Na s G G �17t�-��°'�i'.2 �11� )4�bv��e..���(l� L�J,� 5��t�v �.s�'- /�,�,� � <br /> Applicant Maillnp Atldress City Zip Phone n <br /> ls1 <br /> Dascribe Propo�etl Work � 'u'�`d`"�— — ���� /�—T't-l� ��C�CCJq+.. _ <br /> � (��� Z /� � <br /> C��s���'�-y- M�w�,�-h �+1v..� . <br /> M M <br /> W y �y <br /> f�A S <br /> Project Address{if known) � g �:� <br /> Attech four(4�coplea of plans lor proposed work•Draw to scale and note the following as applicable: � � � I <br /> • Property Linea • Centerline ol street � <br /> • Outline and dfinensiona of ell existing and • Indicate Norih � <br /> propoeed struclurec on the lot • Show any proposed grading c�anges <br /> • Exiatinp and proposeC utillties • Show measurements � �"� <br /> DO NOT WFITE BELOW THIS LINE O � N <br /> PERMIT CONDITIONS N <br /> 1. All calls for inapactlon a�all be made 24 hrs.in ativance• phone 2 5 9•8 8 1 5. � p � <br /> 2. All worY,ahall be Uartormed in aceordance with this permit end currenl City of Everett Design and Construction <br /> 'i7 <br /> StanOarde and Speciticatlons. <br /> 3. Call Locetion Underpround Service 48 hrs.:,efore you Cig.TOLL FREE NUMBER 1•800•424•SSSS. � � N <br /> o,� �5 O � � <br /> 1 '` � �� ��—' � <br /> A1 ��b �P u � <br /> I `� e��..� �� e/iN'�/ O � <br /> 0 �•> y <br /> � � � � <br /> / ����� � � <br /> . H <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appticanl hereby agrees to hold and save Y�arm- <br /> less ihe City of Everett from any and all claims for damages, c Is, <br /> ezpenses. or causes of action �hal may arise because ol installaUon <br /> and mainlenance of the improvement or other�ight-of-way use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> Approvad for Construction Dale Cily and to replace public properry AameBed thereby. <br /> FINAL INSPECTION Date <br /> Approved ea Construcled Signature of Applicant Date <br /> everett PUBLIC WORKS OEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STAFTED WITHIN <br /> � 3200Cedar5lreet 180 DAVS OF DATE PERMIT IS ISS��D AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PIIRSUED TO COMPLETION. THIS r'ERMIT MAV BE <br /> Phone: 259-8815 CANCELLED BY THE C�TY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJFCT OVER 50 DAYS DURATION. <br />