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/ /_.�iES' 3��/�',e Cif'��Ti.rlG '� Z 5- 8F <br /> Datei/� �" Pu�IIc WOrks Permil# n �� // __ <br /> Application For Bia9.u'°�." � � U� <br /> PUBLIC WORKS P'!�RMII' Pu�lictVOBSFee <br /> Totel Feo $- <br /> �ess ApO�-Fee Paitl wS <br /> L^�Q l70 <br /> Balanco Oue � <br /> Print or Type Only �'36�� <br /> �1�,P.P�=% J� C/1G�2yL/ �vlfS �fo� �t7�"ST Lve�� i7 u/d. �?5.��'3 �S� G�Ga <br /> Owner � Mailinq Address City Zip Phone <br /> C!/Gn U�i'y ��p�J <br /> Ca�Pv,�i.✓ Lvs �vM il�,'�S 7�1 .T• t. G��GRG7% r;.�r// v.•.�v �,�s'-GS'a�1 <br /> Applicant Mailing Address City � Zip Phcne <br /> Describe Propcsed Work ��' � �� ����G ��'" _�AM� ��� /C'vS _ <br /> -- /` — � <br /> Prolect Address(if known) 7��- ��t� Sf � <br /> Attach f�ur(4) copies of plans for propused work- Draw to scale and note ihe following as applir,zble: s <br /> • Properry Lines • Centerline of street ♦A <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the lo[ • Show any propo�ed grading changes <br /> • Existing snd proposed utilities • Show measurements p/� <br /> ��I <br /> DO NOT N'RITE BELOW TH�S LINE � <br /> PERMIT CJND:TIO�S <br /> 7. All calls for inspection shall ba made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in accorjance with this permit and current City of Everetl Cesign and Construclion <br /> Stanoards and Specil:cations. <br /> 3. Call Location Underground Service 48 hrs. 6efore you dig.TOLL FREE N�MBER 1•800•424•5555. � <br /> ma <br /> 5� AP����a.�� /j��rr f?�auroE Q Co,Qj- G�' T/,E SEP%�c Sys��m <br /> �E,E'mi> fi�a�n T�t'E cS�r.fo�Yan,iSNc4l�Eo�7:d �i.f%, BE;r✓�E Ci�'y � <br /> f?E.F.y,ir� :-.�J.�cc �?� i f.l�,�O. � <br /> d/ <br /> A <br /> a <br /> ,% ACKNO�NLEDGEMENT OF CONDITIONS <br /> � /(,. <br /> w The undersigned owrcr/applicant heraby agrees to hold and save harm� <br /> less the Ciry ot Everett from any and all claims for damages, costs, <br /> /� expenses, or oauses of actio^ that may arise ber,ause of installation <br /> —�y/�/ / -, 2nd maintenance cf ihe imPrcvemgn! or olher right-of-way use hereto <br /> � � J�<���'�''�2� � � � '�'��— applied for and further agrees to remove same upon notice from the <br /> Approve�nstructio ��//� � ��ite City and to replace public nioGerty damaged thereby. <br /> �l J�� •��2 ��'g-�'�_ G � �.� <br /> FWAL INSPECTION Date �� �� � � L"'� � � <br /> Approved as Constructed gnaturz of Applic nt Date <br /> everett PUBLIC W�RKS DEPARTMENT WORK AUTHORIZ�D BY THIS F7MIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cede�Street BE DILIGENTLY PURSUEO TO COMPLcTION. THIS NERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORIC ON THIS <br /> Phone: 259-8815 PRCJECT OVER 90 DAYS DURATION. <br />