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�810—V�G� � P„bbcwm�ern�mQit�1 -�� : <br /> nie Deo� •_71� �/ <br /> Application °or ° <br /> PUBLIC WORK� F��RMIT r�oucwod�rne - - <br /> To�ni ree s _ <br /> LensA00��ce Pn0 f <br /> Print or Type Only o.�,��eo�e f _ <br /> DAu� ( �Ski I y�C) �ir�c�'. Av�. �(T'�F��$�U 1 ,33�-�3JE, <br /> Owner Mailing Address City Zip Phone <br /> ('r.C�%�� ��� t-bn1Es 7 ►3 sE ���r c U i�� �'�1� G��y 3s�� <br /> Applicant Mailing Address City ip Phone <br /> Describe ProposeC Worh . ,' ����/ I�. �l_YJ �i� LI � /t��l 1 L_TQ._',K.-\ <br /> W <br /> Project Atldress 1i1 known) � <br /> Attach tour(4�copies ol plans for proposed work• D�aw to scale and nole ihe lollowing as apPlicable: � <br /> • Property Lines • Centerline oi st�eet � <br /> • Ou�line nno dimensions ol all ezisling and • Indicate North <br /> proposed structures on the lo� • Show any proposed grading changes <br /> • E�isting and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFiM1T CONDITIONS <br /> 1. Ali calls lor inspec�ion shall be made 24 hrs. in advance- phone ZS9•BBl i. � <br /> 2. All work shall be pe�formed in acwrdance wilh ihis permit and current City of Everett Design and Construction <br /> StnntlarEs antl Specifications. <br /> 3. Call Location Untlerground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /�l/!l"G/� G�.'a!'.CS �E�i�i J"' /GE�T /<CY�6-i.lE'D � <br /> a./3lB 7 � <br /> �� � <br /> O <br /> a <br /> ACKNOWLFDGEMENT OF CONDITIONS <br /> The u�idersigneA ownr.r/applicant hereby agrees to hold and save harm- <br /> le�s ihe Cily ol Eaeretl irom any and zll claima for tlamages, costs, <br /> e:�penses, or causes ol action �hat may arise because of installation <br /> and maintenance of �he improvement a other right�oFway use hereto <br /> applied lor and furthcr ayrees lo remove same i.pon notice Irom the <br /> Approved lor ConstrucUon Date City and to replace public�roperty damaged Ihereby. <br /> �, � .a _ �� <br /> FINAL INSPECTION Date � �+ <br /> App•oved as Constrvcted St�nalure ol Applicant � � Date <br /> everett PUBLIC VlORKS D[PARTMENT WORK AUTHORIZE BY THIS PERMIT MUS1 BE STARTED WITHIN <br /> � 3200 Cedar Slree� 780 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eve�ett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phor.e: 259�8815 CANCELLED DY THE CITY UPOIv ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OV[H 90 DO.YS DURATION. <br />