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.�. _ II <br />y�s � <br />�" '. <br />Applicetlon For �' <br />PUBLIC WORKS P�RMIT <br />Print or Type Only <br />P�DIIc WOA� Pmm� � _JJ� <br />BM7. ad. • <br />GS <br />PuCli rk� FN � <br />7 FN <br />lau g� Faa PUE s�� <br />3Z�� �w.�/ <br />—/ <br />Mailing <br />Ciiy <br />C1•J <br />Describe Proposed Work L nGi`��r� y�v Or Ra�l�c� Qnd <br />. _ _ - ' ' ' - -- - �S, .1,,.,.,/ S.�sw.�/f <br />Prolect Address (il k�ownl <br />Attach lour (4) copies of plans lor proposed work - Oraw to scale and note� CQ°�1erline osstpee'•-able: <br />� Property Lines • Indicate North <br />• Outline and dimensions ol all ezisting and � Show any propose� gratling changes <br />. proposed sfructures on the lot - � Show measurements <br />� Existing and prOposed utilities <br />PERMIT CONDITIONS <br />1. All cells for I�spectlon shall be meda 24 hrs. in advence • phone 259�8810. <br />2. All work shell be perlormed in eccordance with this permit antl current City ot EvereN Deaign and Conatrudion <br />Stendards and Speciticetiona <br />3. Cell Location Underground Service 4B h.rs. before you dig. TOLL FREE NUMBER 1•8f)0�424•5555. <br />� jl/� t/ ;DriM s� c �o -�/ic G vr� Or Si�t c✓a � <br />/ <br />s/t•�� 6� �i�e res�o...ec. 6.'C.�y of' fi�t <br />ocu.�ar �o vc�;,- er r�PLac.e . <br />��� �� <br />������� <br />as Constructed <br />�z��,c.,�.� � �- <br />�J��� � <br />n�,�.,,.��-. <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259-8810 <br />/y�u.<.c.�" .�tiC ��-..ee(' <br />��,� M-�.rt. � �y1,l� �1.��G <br />���-''�L� �`/s_ s- � � <br />3-3- <br />S <br />-� � 'X 5� � <br />� �:� <br />W <br />H <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />Ir.ss the Cdy oPiEveretl Irom any and all cleims lor damages, costa <br />ezpenses. or causes ot action that may arise because of installetion <br />and mainlenance ol Ihe improvement or olher right•ol-way use hereto <br />appl�ed lor and lurther agrees to remove same upon nolice trom Ihe <br />C�ty and to rep�ace public property damege�Llhereby. <br />V�yuu.P" <br />BORDA S OFO D TE PEFMIT SEISSUED AND HEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />