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i <br /> oate�3�dA! ���„�Wo„�F�.,m,�. <<3%,—,.q//3 y <br /> em� o�o� • _�-Q�___cZ�d]7.–_ <br /> Application For <br /> PUBLIC WO�iKS PERMIT PuOLCWmksVee — _ — <br /> ,o�,�F�P S- <br /> �ess nnn� Fer P;uo $�— <br /> �al,vcc Dur. $ l�'—� <br /> Print or Type Only <br /> `f8�3 y� <br /> _,� �- a- �(A rd IYk D �Y�,,lr� �"�—76 r``. 'l t-��!/I uk�lfPo �';r',� 7S 3s�-7�{a3 <br /> � Owner Mailing Ad ress City Zip Phone <br /> � e ��vi � r,-,�+��- �hax S�-1,�I �v�inuim-n� �r�-f�' 7 y5-���('1�! <br /> Applicant Mailing Address � City D•� Phone <br /> Describe Proposed Work YI P C i r1 A I A '�pr/�q�7�'�21� f ��T� ' �/' ��(,j(�/1' J/b 1/i d U� <br /> � c– �,/A�T _ ��V / <br /> / _ _ W <br /> Project Address(if knownl !T��(f y z-����C7�(i-P, �(/ . � <br /> Attach four(4) copies ot plans lor proposed work- Draw�o scale and note the following as applicable: �� <br /> � • Property Linec • Centerline of street � <br /> • Ou'�iine and dimensions oi all existing and • Indicate North <br /> proposed structu�es on the lot • Show any proposed grading changes <br /> � Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> ' PERMITCONDITIONS <br /> j 1.Ail calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> j 2.All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> i <br /> O <br /> � <br /> "� � <br /> O <br /> a �� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tne undersigned owner/applicant hereby agrees 1:hold and save harm� <br /> less the City of Everett from any and all claims for damages, costs. <br /> ezpenses. or causes of .._tion thal may arise because of installation <br /> _�l// � / '/ and maintenance ol lhe improvemrnt or other right-of-way use herelo <br /> '�- ��C•`oT'f�– 7 ��� � — applieA for and further ac�rees to rem.,ve same upon notice from the <br /> Approved lor Constructi � Date Ciry and to replace public property damaged thereby. <br /> �J� -- (v /�o <br /> FINAL�TfJSPECTION � Date - <br /> Approved as Constructed Si , re ol Applicant Date <br /> K AUTHORIZED BY TI-fIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPAR7MENT 0 DAYS UF DA7E PERMIT IS ISSUED AND SHEREAFTER IS TO <br /> � 3200CedarStreet BE DIL.IGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UP�N ANY STOFPAGE OF WORK ON THIS <br /> Phone:259•8810 I PROJECT OVEF 90 DAVS DURATION. <br /> . I <br />