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Date ��d G Publ¢WOMSPr�mi�• �5b - ���' <br /> B�aq.Oeo�-��-�a S <br /> Applicalion For <br /> PUBLIC WORKS PERMIT P°°:oWFP�`°° s <br /> Less Pnpi.Fee Pei� Sp <br /> BTITnCeDuC V C��C'� <br /> Print or Type Only <br /> � r ���.n c�-; �J9C�.f���lnu�sf F�F�v��- /�iR- 9d�r, � ���-,�Z��P� <br /> W� � MailingAddress City Zip Phone <br /> � <br /> ��'d PYLL� — <br /> qpplicant Mailing Address City Zip Phone <br /> Describe Proposed Work n P W f n�r� � � -� <br /> W <br /> � Project Address(il known) �90� - SELlyu,esT �l�E � <br /> Attach four(4)copies ol pians lor proposed work-Uraw to scale and note Ihe tollowing as applicable: � <br /> • Properry Lines • Centerline ol street � <br /> • Outline and dimensions ol all exisling cn� • Indicate North <br /> proposed siruclures on the lol • Show any proposed gredinc�char.ges <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> �� DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•88�$. � <br /> 2. All work shall 6e perlormed in accordaace with ihis permit and current City ol Everetl Dcsiyn and Cor ;iruction <br /> Stendards and Speciliwtions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•42�1•5555. � <br /> � SE��E�� �.e T.�.s H�usE mqy ,eE��„�E �� ��,���� sysTE.�, � <br /> /N uly,ty C9S� f� Pi,i✓ATEZ n�q.✓Hcc�E InISrACC O(� Ti16 <br /> P�b�ic �iU��r-of- uJq� TisEN 1N57�7u A G nl)iA. G�A�.ry H <br /> S/OE SE�✓E�' GG'E�= Tn Ti/F SE�✓E�' �»h'i/�. //\ <br /> �/♦ <br /> 5. Fru.�oa,-���.' F�% Ti,�E /,hu.rE GN^/ NoT dE P�9c�'� O <br /> o�J FLG 1��9iEP_/AL PuSyEv OYE.e TisE S�o,�E, TN/S � <br /> /719TE.ei9L r�UST dE �GNPf7ci�O �E�f (Jd,C, ST9N0g('/JS' n�-' <br /> rp�T.^l�, /nr;si dE D�'t. ..�c�6c!�J %a G�OD b'E�9.c•.✓U' /1J9:'tL'i9�� <br /> T <br /> ACKNOW I.EDGEMENT OF CONDITIO��`: <br /> ihe undersigned owneriapP��cant heieby agrees lo hold and save harm- <br /> less Ihe C1ty ol Everett Irom any and all claims for tlamaqes. costs, <br /> expenses, or causes ol action tliat may arise because of irstallation <br /> ���,�c��? /`� /j/5�L and maintenance of lhe improvement or o�her ric�hPof�way use hereto <br /> appPed tor and luriher agrees to remo:•e same upon notice from tl e <br /> qpprcved for Cdstructi � ' �a�e Cily and to replare public proper;y damage ereby. <br /> �� �� .�-�� � � <br /> �� , <br /> FINAL INSP[CTION �a�e Dale <br /> Approved as Constructed S� natur� p c nt <br /> WORK A ORIZED BY�- N S PERMIT MUST BE STARTEU WITf11N <br /> everelt PUBLIC WORKS DEPARTMENT 1B0 DA OF DATE PERMIT IS ISSUED AND TIIEREP.FTER IS TO <br /> � 3200 Cedar S�reel gE DILIGENTLY PURSUED TO COMPLETION.THIS PLRMIT MAY P.E <br /> Everel�.WA 98201 CANCELLED BY iN[CITY UPON ANY STOPPAGE OF'�NORK ON 1HIS <br /> Phone: 259-8815 pROJEC`O�ER 90 DAYS DURATION. <br />