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�ate 1��g� P�EIicWonuPnmll• 87 3G6 <br /> Application For eao.oaoi.• <br /> PUBLIC WORKS PERMIT PubTol,il�°� . <br /> Less AOG�Fea PeiC / <br /> Print or Type Only TO POSTI BebnceDu� t ���� <br /> Gi8f7g <br /> � +-�-�!-�� �r�4�� �"-�Sr r����,��. y� '7�a�'I <br /> Owner Maiiing Adtlress City �� 2ip phone � <br /> m�r�az a�n�� ���m� P� ��/ IYb� 11jP1L_9-�'i� �-t-.3� <br /> Applicant Mailing Address �i� <br /> Y ZiP Phone <br /> Describe Proposed Work 1 VC/l 1 �.� 1`-V4�4"7�� �- <br /> Project Adtlress(it known) � S- �$Yr7/Ty � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine of street � <br /> • Outline and dimensicns of all existing and • Indicate North <br /> proposed structures on the Iot � Show any proposetl grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hra in advance-phone 259•861 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City ol Everett Dasign and Construction <br /> Standards and Specificationa <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> `� SiTE 4JO.e.f� To B� L�NE f'>,c.� /fr°C'/�.,ol/�D O <br /> Pc 9-v s 1J/JrEv /i i2-97 <br /> � <br /> � <br /> O i <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the Ciry ot Everett from any and all clalms fm damageS coata, <br /> -�� expenses, or causes of actfon that mey arise because ol instelletion <br /> A��on./ � and maintenence of the improvement or other right•of-way use hereto <br /> Qroved lor n pe'e applied for and further agreea to remove same upon notice trom tha <br /> �� City and to replace public property damaged thereby. <br /> .�:.ti-�� <br /> '�NAL INSPECTION Date - � G <br /> �roved as Constructed Sgna re of Apphcant e�e <br /> erett PUBLIC WORY.S DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE 3TARTED WITHIN <br /> 3200 Cedar Stieet 1 B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone: 259•8815 CANCELLED BY THE CITV UPON ANV STOPPAOE OF WORK ON THIS <br /> . PROJECT OVER 90 DAYS DURATION. <br />