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i <br /> � <br /> Date ��__I�C�6� P��������,ksP�,m �0 —3S� <br /> Application For emg uep�.. _ - <br /> PIDBl.I� WORKS PERMIT Pu�icWorasFec <br /> To���F�o s <br /> Less npoL Fee Pnitl S <br /> Print or Type Only e�m��eo�� S 2� <br /> �-��I'l.C��1 � ��'� ��> L�nk ��� j�'] ��� �''� " 33g C�3�5 <br /> wner � Mailin9 Address Gty ` Zip Phone <br /> Applicant PAailing Address City Zip Phone '� <br /> Dzscribe Proposed Work 1\-1� � ! 1 1 ���� ������` � <br /> i <br /> Prolect Address(if knownj ����-� '- /����'. S/' � <br /> � <br /> Attar.h four 14)copiea ol plans tor proposed work- Draw to scale and note ihe following as applicable: �� <br /> O Property Lines • Centerline o(street � <br /> o Ouliine and dimensions ol ali existiny and • Indicate Nor�h <br /> proposea structures on Ihe lot O Show any proposed grading chan9es <br /> • Existing and proposed utilities • Show measurements � <br /> DG NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIOK�. <br /> 1.All calls for inspecti�n sha'I be mar.'e 24 hrs.in advance-phone 259•8810. � <br /> 2.AI!work shall be pedxmed in acccrdance with lhis permit and current City ol Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Serv ce 48 hrs.helore you dig.TOLL FREE NUMBEF 1-500-424•5555. Y <br /> ^ .f��; 14' CH��iVGE SP�I THE I�R:['JE;JfI`( G_IT IHUST R�: F1PF'RO�;I:�.G I <br /> i�a <br /> E:l' TFIE f'UL;LIC l4QFif:t3 ItdSPEC"fOR. � <br /> ?i .�J�;f= f'UHLTC DRAIp�I(1G'_ uYSTEt9 A5 PfiQV.DLD 1=0R DOl'JP!S1 'pi_I���: , <br /> i-li`?Y LUT [�I"iADE CHRN17E5 I`7UST PE (-1FFROVEI? F{l' TFII: <br /> 1'UEI_TC I�JOF��:f3 II,i�=�FF:_r,l'OF;, � <br /> % ":EFI=' CI71' .�'>'fFtEF'f5 CL.cAN (1T ALt_ TIP1E:�. <br /> , irl;T/lI_L wnrr_r BOXES 1"0 GRf1DF A'i 7FIE END OF COh•ISl RU`.:TIOtJ ♦/� ' <br /> 7, PiAf::E SUFif:: llRI'.'EbJFlI'S (1RF COMPLE'fELY CU�iED EF_'FOFF: ��� <br /> liFtI'/:LiUf3 UN '1-Hiil^. � <br /> � _�. ll !1' Df1PtA[-.E TO TFIE CLIRE: (ll`JU SIUF_W(iLki WIL.L B[= REPfiZFi[i:D ' <br /> � [� 1'i�t:[ �'/?TiSiAr;Tfr7b1 r7F TI�f- USI_.f.r: i)r�h�:�; �� _��T . � ', <br /> ACKM����Nl EDG[MENT OF CC�NDITIONS <br /> Thn undereiyned owni�r/applicaM hereby agrees Io hold and save ha�nr <br /> less ihe City of Evn_relt Irom nny and all claims for damages, cos�s <br /> �/5�yt /� + .� j� e�penses, or causr,s ol action that may arise because ol installation <br /> � �, /� Y ,_A_;;�—( p� and main�enance of thr, improvement or o�her righ!-of�way use hereto <br /> *�'� /J- " � applied lor and lurther agrees to remove same upon no�ice from ihe <br /> Apprcvetl ix Consiruc(ion Date Cily and o repl e public property dama9ed thereby. <br /> f'.VAL INSPG:TION Dele ��� J ��� �, <br /> Approved as C�ns(ructr,d Sic�nature o App ican� Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AU OFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA98201 BE DILIGENTLY PUHSUED TO COPAPLETION. TV{IS PERMIT M11AY BE <br /> Phone:259-8870 CANCELLFD BV THE CITY UPON ANY STOPPAGE OF WORK ON THI3 <br /> PROJECT OVER 9G DAY� DURATIOM. <br />