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Date�� 9�
<br />��plicahen For
<br />PUBLIC WORKS
<br />Print or Type Only
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<br />Applir,ant
<br />'^ ���TING_� L�
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<br />.��In�: Adtlmss '__ —____' __ _— _ —'
<br />Describe Pronos�d l4'ork �/����� �� %� 0 T
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<br />Prolecl Address lif known` X //C'�� /J �_`U.ET/iIC✓�_ —_���Yj (
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<br />At�OCh fOUr (41 COD�CS o� Pi�nS la� proP��:;�d x�<'�. D�.lr: �;i _,:,il�..�_'.,� --„'.� Ihp'cilln::inq a5 aGlibC3h1��
<br />• PtOpetlY LineS • G���Inrbnn nt 57ree1
<br />• Outlme and dimensions of all e,�ie;nq ;n,d • Ir�7,�;3b� �nrih
<br />proGos�'tl slrucWres on Ine IOr � S��o�v .+nr ::ro;)o5ed t7ratl�nn ,:haruns
<br />• Esistin�� and prouosed u�ildms • Shn.: c�,:,3suremenis
<br />PERA4IT CONDITIONS
<br />1. All calls for inspeCtion shall be matle 24 hrs. in advance - phone 259•$$i 0.
<br />2. F:i work shall be peAormed in accordance with ihis permit and curtent City of Everett Design and Consiruction
<br />3tandards end Specifications.
<br />3. Call Location Underground Service 48 hrs. belore you dig, TOLL FREE NUMBER 1-800•424•5555.
<br />�% � "�1 lUDr.� 7�i .Xc C+'OnE �r �C<<i�S G��J/�n�ic�
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<br />ACKNOVJLEDGEAAF_Ni OF CONDITIONS
<br />i.,�� �r,d��r����n��d owne�'appl�cani hereby agrees to liold an, sAee harm�
<br />,. ... ...�. �:��Iv o� Evercit trom any anA all daims lor Azmr�oe�, ,-.os�s
<br />ensP9 or r.duses ol �ct�on thlt ntay ar�s9 because J� �151all�hon
<br />maintenanr,e n� thr improvement or o(hei nghl-of-we_ i use hr.reto
<br />i.�: I�� �nd h,�ihrr aqrees to iemove samc upon nouce 1rom Ihe
<br />. , � �n �„uL�c�� ruClrt: � �o��•rfy damage.l ihereby
<br />������1�/ �-ls-vy
<br />Sion,itlna o' Ap��bcAn� Da�e
<br />l';CiF.I: AI�ibIOBIZF_D BY THIS PERPdIT MUST BE STARTEIi WITHIN
<br />tgp DAVS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO
<br />9E DIUGCNTLI' PURSUED TO COMPLETION. THIS PERMiT tdAV BE
<br />CtJJCELLED P, f TFiE CIiV UFON AN1' STOPPAGE OF WOFK ON i HIS
<br />PPO.IECT OVER 90 DAVS DURATION.
<br />Appw��� n - 9 Gonstructed ,
<br />PUBLIC WORKS DEPARTMENT I
<br />�y'j 3200 Cedar Sireet
<br />�� Everett, WA 98201 ',
<br />Phon=: 255�BB10
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