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D818 ����� ADPlicatioi� For <br />pUg��C WORKS �"ERMIT <br />Print or Type Only <br />� ybz� <br />lddress <br />Address <br />.nii <br />Describe Prop�se^ o�k <br />S E � r} ��zsi' <br />�_ <br />u <br />PuebcWo���Perm�l� _ �� --- <br />&Ep Deot • ��--- <br />----�— <br />r�,b��c workc f� <br />to��� Fee <br />le�s �oot fee Pua t' —�� <br />BdwceDue ��_.� � <br />Zip <br />TT � LU=-- <br />TF�"eiii��OzO�% <br />'r — licable. <br />Prolact Address Iif known) <br />Atlech lour 14) copies ot pl�os for proposed work - Oraw lo scale and note � CQoltewine ot street <br />• Indicate North <br />• PropertY �ines � ghow anY P�oPosed grading changes <br />• Outline and dimensions of all existinp and • Sh�W meas�rements <br />proDosed strucl�u�osed ut It ies �—� <br />• Existing and P P iNF <br />PERMIT CONDITIONS <br />ermit and current City ol Everelt Design and Conslruction <br />1. All ca�l6 �or insPecUo� sha�� be made 24 hrs. in ad�ance - phone 259-88 <br />2. All work shel� be Performed i� accordance wilh Ihis p <br />Standards and Speciflcalions. <br />3. Cell Location Under9round Service 48 hrs. Uelo�e you dig. TOLL FREE NUMBER 1'B�S���` �� <br />i] <br />y. ���,�U�� �,« �-��. <br />��` C'i.�/ �E-s'/�'n) <br />s ,Ttrn1���'- /��h( <br />for <br />ru�..�..._. __ <br />Appro�ed as Constructed <br />PUBLIC WORKS DEPARTMENT <br />everett 3200 Cedar Sireet <br />� Everett. WA 98201 <br />Phone'.259�8075 <br />// <br />� C!�!_ �C' � / l <br />f�v_„l,n T`('ucT��/ <br />��,`: .s� �- �'�-s . <br />W <br />r <br />� <br />� <br />Q <br />N <br />� <br />a <br />/`� �I ACKNOWLEDGC-MENT OF GONDITIONS <br />�' The unders�gned ownedePP���ant he�eby agrees to hold and save harm� <br />less Ihe Gity ol Everelt Irom any 2nd e�' cla�ms lor tlamages, costs, <br />e impfo�zmenl o� Othef fight�obway usr. hereto <br />expenses, or causes of aclion thal may a�ise because o� installation <br />��' and mainlenen� <br />� appticd 1or and lurther '�Qenertvrdamaged Iheretrn no110E'��m �ne <br />and to rey� <br />� �� <br />ISi9nature ot cant <br />�gORD YSTOF DAT�E PERMIT SESSUED AND THEREAF �ER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PROJC-CT OVEF SO DCYS DURAT ON. STOPPAGE OF WORK ON THIS <br />� <br />� <br />� <br />�� <br />y ., <br />�� <br />�� <br />r. <br />�� <br />F <br />�� <br />� <br />gq ;. <br />Hy � <br />K` <br />O; <br />r' <br />� F. <br />,� <br />�; <br />� F. <br />