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, <br /> Dale��«� �� � <br /> r�oi��wo,xs ao,i����. — cr / �� <br /> Application For � �_y4�°P��"_ ���, <br /> RU�LIG WORK� pERMlT v������v���sF�� ' <br /> ,��a,��� : <br /> Les:aon�.Fec Paia S_� I <br /> Print or Type Only o,�,�=�o�P s _ � <br /> �YYLkI�c`��� i 7?�'11 I; _ f�� � C�J� ��1����"-�--3`�Q'� <br /> Own�—� Mailing ddress Gty Zip Phona <br /> �-�}'I,P"�— <br /> Applicant Mailing Address City Zip Phone � <br /> Describe Proposed Work �`l� ( �� � I� � L (�r� <br /> %09�7- ,iQ*:,1� � <br /> Pmject Address(if known) �; �F_ � <br /> Hitach tour(4j coples of plans lor proposed work- Draw to scale and r.e,!e the following as aH,licable: a� <br /> e Property Lines • Centerline ol street ,�I� <br /> • Outline and dimensions ol all existing and • Indicate North , <br /> proposed sVuclures on �he lot • Show any proposed grading changes <br /> • Existing and pwposed utilities • Show measurements '� <br /> DG NOT WRITE BELOW THIS LW[ � '�, <br />� PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 2�� n•s.in advance-phone 23A-$810. � '�. <br /> 2.All work shall be pedormed in accordan..�: ;iL� this permit and cwr.-nt Ciry of Everett Design and Construction ; <br /> Standards and Specifications. �, <br /> 3.Call Location Underground Service 48 hrs.be(ore you dig.TOLL FREE NUMBER 1-$00•424•5555. � ,i <br /> I�1' CI 'f I�Uf:: 11; l � i'r. D'' i:'E44f�r ' UT ;II I(; i I=�E (1FPF?04'ED � I <br /> i l Tllf I UPL7r t40R6.S TIVSFCr r�R. <br /> �..::�f' PI_JHLIL' I)Fif�I�lA6C SYS'fFl°I AS i'FOl'lD�i� �(lf: ll(�UiRlE3i i-d_rif_ . <br /> 'iiQY L.OI" [ih�DE CH1iJL;GS I`1USi E4E AI'F"fi0,:'! � r•`( l"ill : � <br /> i'UF�I_iC IdOFF:� T�I�FCCTUR, � I <br /> i I F' CITY SII�Lf f•'3 Cl1=AN (1T AI 1_ TItil ' . � <br /> � IV''iAI..L. 4!A'tCr� LiU tE' TO G�ti`DF (1T 'f I II t i � i iL i i ��-. Il:l :': I i Cil•I � <br /> � r <br /> ill`l:E :;URf= DR:[VC�JA`(9 A;;[c COf1FLETELY �:iJr � i � EF�) ,I _ � <br /> ' ;�L Pal3 ❑I•d 7HEP1. � <br /> I I. . D(1hir11; .F. TO TIiE CIIRH �iP.ii) ;IDEbJ(11..1': L�iiLl_ E�E FEF(-lJ:fii:'D <br /> ��n �;. �::1`�i i ,I ' = i ' ]P�I i��r ' fP P'i u ' i' ��uJ . iiF=F'�f, <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> 7he undeisgned owner/applicant hcreby agrees to hold and save harm- <br /> less the Ciry ol Everett from any and all claims for damages, costs. <br /> � � ] ' ezpenses. or causes of aclion ihat may arise because of installation <br /> �_ �,/��.� � /!� `dL� and maintenance of Ihe improvement or other righ�-of-way use hereto <br /> � applied for and furiher ac�rees to remove same upon notice from ihe <br /> ApProved(o* Consiructic —� / ate <br /> � � Ciry and to replace public property damaped the�eby. <br /> j��.� �L /� l/� / ��� �� �j � � <br /> �;��� �.S � � (� <br /> FI L"�1NS�CTION�- ` f D t � �""'� ���'� �—}��9g � <br /> Approved as Constructed SignaWre ot Applicant U Date <br /> i�vrretl PUBLIC WORKSDEPARTMEN; WORK AUTHORIZC-D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO , <br /> EveretC WA 98201 B[ UILIGENTLY PURSUED TO COMPLETI(lN. THIS PERMIT ��1AV �P <br /> Phone:259�86I0 GANCELLED BY THG CIT1' UPON�NY ST�OPFAGE OF lh'ORK ON Tf-{I: <br /> PROJ6GT OV[R 90 D�YS DUI7ATIOIJ <br />