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\ <br /> � <br /> Da,te�JQ�/�' r�m��wo,�s r�,mnn��bb./ <br /> � ' �io9 Dap� •�_1/Q� f_ Z��� <br /> Application For <br /> PUBLIC WORKS PERMIT `'°°:o,w�;�F°° : <br /> Lev RO�� fee Pn�J s <br /> UnienceDuv s <br /> Print or Type Only I <br /> �.i/�eo_.�c�1��L)�� f ��/a J'�n�,LDr ,E���I1f 4d'z4�/ 356-/a!� � <br /> Owoer Madmg Address Gty Lp Phone <br /> ClNltlar���e AQtrl���nrrS,tcQ �o 3c3��...�- 5�sfflo Q�Y2l ��// -�/522 � <br /> Applicent Mailing Addres� City Zip Phone <br /> {,, -r� � <br /> DescribeProposedWork RPnDvp�Q„ inFz 2 0<<� ,F��/tt(e,r' ✓uMiG/ /7��n � j <br /> I <br /> n/� WI <br /> Prolect Address(il known) �,o) �)IIG?.� �✓' � <br /> Attach four 14)copies ol plans lor proposed work- Draw to scale and nole the lollowing as app6cable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> c.:� <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with Ihis permit and wrrent Ciry of cveretl Design and Construction <br /> Stendards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.before you dip.TOLL FREE NUMBER 1•800-424•5555. � �� <br /> �U.�BC/G cUC�i�.�s f�i_';E'/ti/T�OT .t�'_F�vi,P.gll� O <br /> `���3�gB ~ <br /> N <br /> O � <br /> ��;' �� � �a�.,, .��- �-�-� ��=n-w o. i <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 1 he undersic�neo owner/apPlicant hereby a�rees In hold and save harm- <br /> --�� �- �— less the City ol Evorett Irom any and all r.laims �or damages, costs. <br /> eMpenses, or causes ol aclion that may arise heceuse oi installation <br /> ard maiNenance ol ihe improvemen� or other nght�o:�way use hereto <br /> ._ ___—___ applied for antl lurther a9rees to remwe same upon notice irom ihe <br /> Approved lor Cor.str�ction Date C�ty and to replace public properry damayed lhereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructetl ;ignature of Applicant Date <br /> WnRK AUTHORIZED BY THIS PERMIT MUST BE ."iTARTED WITHIN <br /> evrrett PUBLICWORKSDEPaH7MENT 18J DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cetlar Sireet BE DILIGENTLV PURSUED TO COMPLETION. THIS FcRMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY TI�{E CITY UPON ANV STOPPAGE O`=INORK ON THIS <br /> Phonc:259-BO1G �RGJ[CT OV[F 90 DA�S DURATION. <br />