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O _/ <br />Date � Z 'r �c--�O —Z�f—S ��o�,�wo�.sP�,m��, /�—Z/(o <br />Applicatian For emg Depl •__y�j_�c�_J�1 l <br />PUBLIC WORKS PtRMIT Pu01¢WOrhSfee --- <br />Tolal Fer S <br />Frint or Type Only <br />Less RCO�� Fee Pa�tl $ �_ <br />8��.,��e o�� s 5D •? <br />S�anwoicc/ 7cPa9a CS�—sdL76 <br />City 2ip Phone <br />S q,� �. <br />qpplicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />p;olec� Address (if known) <br />L �3 Z s�� : <br />Attach lour (4) copies ol plans lur proposed work - Draw to scale and note the lollowing as applicable: <br />• Properry Lines <br />• Outline and dimensions of all existing and <br />proposed structu•es ..n the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate No�ih <br />• Show 2ny proposed gradinc� changes <br />• SI•�ow measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pertormed in accordance wi�h ihis permit and current City ol Everetl Design and Conslruction <br />Standerds and Specificat!ons. <br />3. Call Location Underground Service 48 hrs. be�ore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />T, <<yf.-�,.-•2� � .� �%'�clu.�f .-Z�o Gr�p�e� �t,eC�s/ -,�'X/n�u �.Cl <br />� �.c.�J/ s��% `� '�30.3 �.�,c�w7��(/ �r�a.�. <br />d�-�.� c..�6 � �ct� .G� <br />�,t� /2Pg� .�' %� J"r,xc� a., �Q.e�z�ozn„a�,.�� <br />5 . ��a / OuJ�' �' ,�*,�',l�i"'S' �'ru� LJ[CC' ��' .C� <br />71,�.. 6, <br />3�- <br />Approvad as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF C)ND' i IONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hen by ayrees lo hold and save harm� <br />less the City ol Everett irom any an I all claims for damages. costs. <br />expenses. or causes ot action Ihat r �y anse because ol installation <br />and maintenance ol the improvemmit or other rigM-obway use hereto <br />apP��ed lor and lurther agrees lo remove same upon not�ce '�om Ihe <br />Crty and to replace public property damaged thereby. <br />1�� ' � i'V <br />. igna�ure o� ApplicaN Date <br />WORK AUTHORIZFD BY TIiIS PERMIT MUST �E STARTED WITHIN <br />t80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />6E DILIGENTLV PURSUED TO COMPLETION. THIS PERh11T MAV B[ <br />CANCELLED BY THE CIiY UPO� ANY STOPPAGE OF WORK ON 1NIS <br />PROJECT OVER JO DHYS DURAT{ON. <br />