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oete� q3 � = <br /> . Puelic Work�permtl• <br /> Applicatlon For emo oep�.. <br /> PUBLIC WORKS PERMIT F�D���W��.F.. <br /> .o�.�F.. • <br /> Lan Aopl Fae P��a S <br /> Print or Type Only BH�nca Due s ?0� <br /> n Owner Mailing qddress City Zip Phone <br /> -Ye.n eaG 7,10� �e,il c�-r Lr�.�o �e,,en s I`�t'ZS y � 3 4� 1`l Z� <br /> Applfeent Meil�ng Adtlress City Zip Phone <br /> Describe Proposed Work �S�L�/'Q� U T�Q.$ .�p/� �JQ^rU ���— �� <br /> . �u���� <br /> Pro�ect Addreas(if known) O ( � �XE}(J(Q,�-- �V Q,��'�� P� � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note the(ollowing as applicable: � <br /> • Property Lines • Centeiline of street � <br /> • Outline and dimensiona of ell existing entl • Intlicale North <br /> proposetl structures on the lot • Show any proposed grading changee <br /> • Exletinp and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All callt tor inepactlon ehsll be made 24 Are.in advance-phone 259-8810. � <br /> 2.All work ehall be peAormed in axordance with thie permit and current City of Everett DeslOn end Constructlon <br /> Strndardt and Specifk:ationa <br /> 3.GII Location Underqround Service 48 hn.beforo you dip.TOLL FREE NUMBER 1�800�424b6:S. <br /> 'f� An��/ '�'+� G�t � f��scusscd, �� >�yttt V�Sr� .✓:fJa 5 F•c�i.�w.r � <br /> h��+lc� n+a� h� r'�toved. O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �S�t:OMV11 �'at,t� �� 1 (� The undersigned owne�/appiicant hereby aprees to hoid and save harm• <br /> r i" less Ihe City of Everetl irom any and all claims for dameges, wsts, <br /> ���C� expenses, or causes ol action thet may arise becauae of Instelletlon <br /> �� b� and maintenance ol Ihe improvement or other right•ol•way use hereto <br /> Ap roved for natructlon ��Date applied lor and further agrees to �emove same upon notice from the <br /> Ci�y and to replace pub!ic prQperty damaged thereby. <br /> � S 6P �Jj,� /� �^ G� <br /> . F� � . Det ///•��(�J/1 /%✓/4'�i ri -� N <br /> Approved as Constructed Si�tu�e Applica t Dete <br /> PUBLICWORKSDEPAqTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200Ceds�Slreet 180 DAYS OF DATE PENMIT IS ISSUED AND THEREAFTER IS TO <br /> Everott WA 98201 . BE DILIGENTLY PURSUED TO COMPLETION. TMIS PERMIT MAY BE <br /> Phone:25&BB70 CANf:ELIED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PRCJECT OVER 90 DAYS DURATION. <br />