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� <br /> - <br /> D$tB �I � � .. �� PUDiK WorM�P�r • <br /> Application For eiao o.w.. <br /> PUBLfC WORKS PERMIT P�DIKWorR�Fw <br /> Toul Fe� _ <br /> Lau�ppl Fn PUU = <br /> Print or Type Only e.�,�no�. t <br /> �L�����aw��o �?�/5� ��,�.e�.� /�� Ss7/ <br /> Owner MaiNnq Address City Zip Phone <br /> � <br /> Applicant Mailing AdCress City Zip Phone <br /> Oeacriba Proposed Work �--�-�-Cx l v " �4.� �a�-�.� — C�e_�f-�-�L..-�,i <br /> � <br /> Project AdEreas pf known) — ��� � <br /> Attach tour(4)copiea of pla�s for proposetl work•Draw to scale and nole the following as applica6le: � <br /> � Property Lines � • Centerline of street � <br /> • Outline and dimansions uf all existing and � Indicate North � <br /> proposed structurea.n the lot . � Show any proposed graCing chanqes � <br /> • Existing an�1 proposed u:ilities • Show measuremenis � <br /> � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shal�be mede 24 hrs in advance•phone 259•8$�$. � <br /> 2. All work shell ba paiiormed in accordance with this permil and current City of Everett Design and Construction i <br /> . Sta�:darcls and Speeificationa . <br /> 3. Ga�l�ocatWn Underground Service 4B hra before you dig.TOLL FREE NUMBER 1•800•424v555. � <br /> . � <br /> �jl. /�U�3'G�C G�JD.ei�"'-s' fE.c'.ss�T �t/oi�Ec.�Gv,e�� � <br /> �� //-1v-�4.s � <br /> . V: <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save ham <br /> less Ihe City of Everei; hem any and all claims for damages, wst. <br /> expenses, or causes ol action ihat may arise because of installatio� <br /> and maintenance ol the improvement or other right•of-way use hereb <br /> applied tor and turther agrees to remove same upon notice Irom th� <br /> Approved for ConStruCtion Dale City and t0 replace publiC property damageG thereby. <br /> FINAL INSPECTION Date <br /> Approved as ConsVucted Signature of Applicant Dat? <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHi� <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS T� <br /> Everett,WA 58201 BE DILIGENTIY PURSUED TO COMPLGTION.THIS PERIv11T MAY B: <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI' <br /> PROJECT OVER 90 DAYS DUAATION. <br />