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/���/,(\�'�y/ piAiic Woiks Pr,rmit F ��� '7�V <br /> Date_ 1/!_1!_L) ! BI09 Dept.s <br /> •r i <br /> Application For <br /> pt1BLIC VII�RKS PERMIT PVbTo�elFerFea g <br /> Less Appl Fee Paitl g <br /> 5alancn Oua S `���•�U <br /> Print or Type Only � l� ��� <br /> � <br /> �` �;�; / ��� ��U�/d� ��_�`�?` . ���;s'-y�/_� <br /> Owner Mai6ng Address CiN Zip Phone <br /> z <br /> 0 <br /> ��I1-Q..- ---- -- — .-. <br /> Appli ant Mailing Address City Lp Phone m <br /> Describe Proposed Work �'�c� --I Ti <br /> �. -i <br /> in x <br /> 0 <br /> m <br /> _ � co ; <br /> mo � <br /> � -i c 1 <br /> Projer.t Address(i� known) <br /> ���� ��n ^ � (1^ L�. � m � <br /> �0 x -i <br /> Attach four(4) copies of plans for proposed work• Draw lo scale and note the lollowing as applir.able: m � <br /> i Property Lines O Centcrline of street � �o a � <br /> • Indicate North � <br /> • Outline and dimensions of all existing and O Syow any proposed �radin9 changes r = � <br /> propused structures on tne lot � � ^� <br /> • Exisling and proposed utilities i Show measurements -1 v� I <br /> -G <br /> � , <br /> DO NOT WRITE BELOW THIS LINE �/� � � . <br /> \�d -i m <br /> PERMIT CONDITIONS = <br /> rn � <br /> 1. All calls for inspection shall be made 24 hrs, in advance- phone 259•SS1 5. en � <br /> 2. All wuik shall be performed in accordance v:!th this pennit and w�rant City oi Lverctt Dcsi9n �nd Construction oo r <br /> Standards and Specificalions. � m � <br /> � C N <br /> 3. Ca:i Location Underground Service 4F3 hrs. before you d�g. TOLL FREE NUM6ER 1•800•4^<4-5555. s �, <br /> z c'� , <br /> � ;i r <br /> j ' <br /> � <br /> -� <br /> � ' <br /> ➢ <br /> z ' <br /> � � <br /> S ' <br /> N <br /> � C <br /> � <br /> � r <br /> � <br /> ACfUJO`NLEDG[MENT OF�ONDITIONS <br /> The endcrsigncd owner/applicanl hereby agrees to hold and save harm- <br /> less the City ot Everett irom any and all claims for damages, cosls, <br /> expenses, or c2uses of action that may arise because of installation , <br /> �� � / �i and maintenance ot the improvement or other rigM-ot�way use hereto <br /> �O"a7�� ���j��`" appf=d for and Wrther agrees to remove same upon notice irom lhe <br /> Approved tor , slr tion Date C;ry and to replace public property damaged ihereby. <br /> � � � - _ --����"�,,G�� /-��/�/�� <br /> FINAL INSPECTION Date � Date <br /> Approved as Constructed ignaWre o�Applicant <br /> WORK AUTHi�RIZED BY THIS PERMIT MUST BE STARTED WITtiIN <br /> everett PUBLIC WOfiKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200 Cedar Sireet BE DILIGENTL'! PURSUED TO COMPLFTION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 GANCELLED dY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pHOJECT OVER 90 DAYS DURATION. <br /> Y <br />