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Date �( y/ <br /> � � ��� Pupl:c\Yarke P�ermlt• `�� �� <br /> App:iCation Foi Bm� Ucp.s �� .�� <br /> PUBLIC V!/O�iKS PERi�IIIT 5�mroWFoeFeo 5 �-a .e70 <br /> Le:sApplPeePaiO � <br /> Frint or Type Only <br /> palu i�o Due $ �`-4•U O <br /> i � <br /> %;.. � G ��7� <br /> � c�iE��" G� �i�i���� �^i S'� � �.���/�i��l.1i�N � � ��� »�; 7�I� <br /> Owner btaihng Address City Zip Phone <br /> 5,�� <br /> Applicant MailingAdd;ess City Zip Phone <br /> > ,� <br /> Describe Propnsed Work �l�i� .�%l/!i/,� ���/�/l� <br /> _ r.�. <br /> Project Address(if kncwn) �V G O 3 �O � — �i-, S'.�, r,e-��,c L,,� �2/ � <br /> Atlach four(4) copies of plans for proposed work- Drav.�to scale and note the following as applicable: � <br /> ! Properry Lines • CPnterline of street � <br /> • Outline and dimensiuns of all existing and e Indicate North <br /> proposed shucWres on the .ot • Show any proposed c�rading changes � <br /> • Fxisting and proposed u�ili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE I <br /> PERMIT CONDITIONS � <br /> \ I <br /> 1. All calls for inspoction shall be made 24 hrs. in advance-phone 259•881 5 � <br /> 2. All worl<sSall be performed ir accerdaoce with Ihig permil and current Ci�y�.�f Everett Design and Construction I <br /> Stand2rds and Specifications. � <br /> 3. Call Lt�carion Underqround Service 48 6rs. bclore you dig.TOLL FREE NUMBr:'. �-800•424-5555. �`: <br /> � ~ <br /> C <br /> � .. <br /> � H � <br /> � � F <br /> r� - <br /> � C <br /> � � r <br /> C] � <br /> � G � <br /> i <br /> o�. � . <br /> rJ ;� <br /> C <br /> AGKNOV✓LEL'GEMENT OF CONDITIONS � '�. <br /> The undersigne:f owner/appUcanl hereby a�rees to hold:nd save harm- � �- <br /> y�'�(� less the City of Everett from a�y and all claims for damages, costs, �-: <br /> �— � exper.ses, or causes of action ��hat may arise because ot installation O F� <br /> �K� 3-/}—•F �/ and m:iintenanCe of the improvement or other right-ohway use hereto <br /> applieo for and further agrees to remove sam� upon nrtice from the <br /> �pprove or truchon Date City and to replace public prr,perty damaged thereby. ;=; � <br /> V„Q 0 �'C� . J_�/� �� � . <br /> > � �� � �` <br /> FINAL INSPEC ION pate � '�� <br /> Approved as Constructed Signat ol Appli Date r � <br /> everett 'U�LIC WORKS DEFARTI�9ENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHR�� - <br /> � �OCedarStreet 1�0 DAYS OF D4TE PERMIT IS ISSUED AN[' THEREAFTER IS TO � <br /> �retl, WA 98201 BE OIUGENTLY FURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> � hone: ?59��81 5 CA�CELLED 8Y THE CITY UPON AtJY STOFPAGE OF WORK ON iHIS <br /> PROJECT OVER 90 DAYS DURATION. <br />