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�Zte�O V PUUI�c WorMnPermlt• � <br /> Application For BIEO DeOt• <br /> PUBLIC WORI�S PERMIT luoTo�Fee`�� �—z� <br /> Lere�po�Fee PsiO s— <br /> Print orType Only e.�.��sn�s i � <br /> ��AI C 16vt/L�1(T �B�C� �A/ese J � ci6�'►TJ�� 7 Q l(� / C�J d � c�O Q.� <br /> Owner MaiHng Address City Dp Phone <br /> � �i,�a� v �it-fiF�ti �.�c-� 9�/n i�Ii�'c�F-+rcp../� 9'�9ay �S379o� <br /> Applicant Mailing Adtlress �ly 2ip Phone <br /> DevcribeProposerlWork SY%oc,K x(iC�. �� � kt� Jb�AK�.►�c....� _ <br /> ProjectAddrass(ilknown) ���-3 ,�Cuc�Cf.» /".I.Lti � <br /> � <br /> Attech four�4)copies of plans for proposed work-Draw to:cale and note the lollowing as app�icable: � <br /> • Property Lines • Centerline ol slreet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed siruct�res on the lot • Show any proposed grading changes <br /> • Existing and prcposed utilities • Show measurements � <br /> DO MOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall�e made 24 hrs. in advance-phone ZS9•88�5. � <br /> 2. All work shall be peAormed in accordanc� with ihis^ermit end current City ol Evr.rett Design and Construction <br /> Standards and Specificetions. <br /> � 3. Call Location Underground Service 48 hrs. before you Cig.TOIL FREE NUMBER 1-800•424•5555. � <br /> � / �y� ���✓Clli� te U �---Q. �// A�N ZUv <br /> � / <br /> d r�;,.dn �'-�f l:� /]/Icors�u// G�Qpta� � � <br /> � � � <br /> S. �.�,r SE/'.� B�,�e 9 (� <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tta undersigned owner/applicant hereby agrees to hold and save harm• <br /> -- less Ihe City oi Everett irom any and all cixims 1nr damages, costa <br /> � /% expenses, or causes ot action that may arise because ol installation <br /> �� i and maiMenance oi ihe improvement or otnar right-of�way use hereto <br /> applied for and furiher agrees lo remove same upon notir,e Irom ihe <br /> � A e or st ion Date Ciry and Io replace public property damageC thereby. <br /> � � �7'� �� ,� <br /> L INSPECTION te <br /> ��'-."�T�/�.� ����Ov �'�o <br /> Approved as Constructed S gnature Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Ceder Street 180 DAYS OF DATE PERMIT IS IS�UED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE D�LIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> Phone: 259-8875 CANCELLED BY THE CITY UPON ANV STOPPAGF OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />