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Date_��� , , Public WaAe Permit• �/� <br /> Application For B149.Oe0��• <br /> PUBLIC WORKS PERMIT 8y ���� g <br /> Pu01i�Wmks Fe s <br /> Totalfea <br /> Leae AOp�Fee PeiE S <br /> Prini or T��pe Only B.�a��,o�e S_� U o <br /> 6G6 y� <br /> �S'Te�e \ �A���JT/n) �3� -S� c�c� <br /> Owner Mailing Address City 2ip Phone � <br /> e1_�,� .��(�s C'�ti,�,.�7- o���.� ��{ ,� .ST���,�� 9�as� � .� y-k�Fs" � <br /> ApP��cant Mailing Address City 2ip Phone <br /> Describe Proposed Work 1 -w � _ ,; ._ <br /> H H <br /> H '8 <br /> � � <br /> Project Add�ess(IF known) S �� � �B4 U i!w ��n � 'y" <br /> Attach four(4)copies of plens lor proposed work-Draw to scale and note the followin as applicac,le: � o � <br /> • Property Lines • Centerli e of street � � � <br /> • Outline and dimensions of all existing and • Intlicale Norih H <br /> � Z <br /> proposed siructures on the lot • Show eny proposed qr9ding chenges � <br /> • Ezistin�and proposed utilities • Shox�measuremenis � <br /> M <br /> N <br /> DO NOT WRITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS �j <br /> 1. All calls for inspection shall be mede 24 hrs. in aJvance-�:hone 259•8615. � � <br /> 2. All work shell be parformed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specifications. 4 <br /> 3. Call Location Underground Service 4B hrs. before you dig.TOLL FREE NUMBER 1•800•4ZO•SSSS. � � � <br /> � T ^� �� . . ^ 1 f <br /> .1Ma�w�� J� �.+�.�..w�wv.. h. �. ` p's ��rT ��.�t �Of Or�r�p O � <br /> ♦ n ( � <br /> S�s�ew , L.�e ...ws�' `rwv.`�� �ee�[ .., . . <br /> � ` Q�C�'y � n� G. <br /> 9ewv w..w... �• �f.v� 0�.�.n�. SM�rC�M M�� � � <br /> b� a l�SM+ I��� ,-b,,,, , ' � z <br /> /� -F 1�o ks� � M.�+. �P»-'�w � <br /> �'Nwb�' bt �J �A.Gr.�Y � �owSG ho � e..� � ow ��lp� N <br /> �aCA�e� ��� ww. d^ro... �o.yt O � <br /> � � ��� , a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apNlicaM hereby agrees to hold and seve harm- <br /> less Ihe City ol Evnrett Irom any and all claims br dameges, cosis, <br /> expenses, or causes ol action ihat may arise because ol installation <br /> � �� `' and maintenance of ihe improvement or other right�of-way use hereto <br /> —� applicd tor :.nd Iuriher agrees to remove seme upon nolice from the <br /> r tl lor Const ction � e City an to ace p lic property damaged thereby. <br /> —� <br /> � � - -��-_— <br /> �� <br /> F L I�ON Date �' ^ � <br /> Approved as Constructed Signature o 9 licai t Date <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHOFlIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> O 3200 Cedar Street 180 DAYS O�' DATE PEPMIT IS ISSUED AND THEREAFT[R IS TO <br /> Everetl,WA g8201 BE DILIGENTLY PURSUED f0 COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANC[LLED BV THE CITY UPON A�Y STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />