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Date�� n�oe�wo,ks a��m��_ �f�' `� <br /> �--- <br /> Application For emq.oeo��<�.$�f�J? _ <br /> PU�LIG WORK� R�RIIfiIT PubhCWOikSFeC <br /> Ta�,�F�� s_ <br /> Lrs Apn�.Fee Paia $ <br /> Print or Type Only e�����eo�� s ZU� <br /> /�'far�.�l ��hS'fYUCfi�a �°�, Ttic. �o/_r- a S�'`�S� /3e/itio�U u, ��azr C�7/-9iY� <br /> Owner Mailmg Address City Zip Phone <br /> �'ih2-2 <br /> Applicant Mailing Address Ciry Zip Phone <br /> Describe Proposed VJork �J:n 9,�� lrG/n7���f ��-!S/�,Pls� e <br /> �, 0 7t 7 ,�_Q h SPh I'tt J-ft ,,— <br /> ProjectAddress�if known) �09�G� —' ������E'- .SE, � <br /> � <br /> Atlach four 14)copies ol plans for p,-oposed work- Diaw to scale and note the following as applicable: � <br /> • Property Lin�;s • Cenleiline ol street � <br /> • Ouiline and dimensions of all existing antl • Indicate Nor�h �� <br /> proposed structures on the lot Y Show any proposed gradir.c� changes <br /> • Exis!ing and proposed utilities O Show measurements � <br /> DO NOi WRITE BELOW THIS LIME � <br /> PERMIT CONDITIONS <br /> 1.All calis for inspection shall be made 24 hrs.in edvance-phone 259•8810. � <br /> 2.NI work shall be perlormed in accordance with lhis permit and current City of Everett Design and Construction <br /> Standard^and Specitications. <br /> 3 Call Loc2'bi�Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1-800•42h•5555. � <br /> i - r, i - <br /> -�: , , � � ._... . .. „�.'�I ,.�.� .. i �..i'� . <br /> ">E 1='UI'tLIC: ilS:AT!`!ACC 5:�,;r�l°i �"��, t'I'.��:'7'1�Ep FnR � <br /> ;hIY L(]T GRAL!C CHPNGI .:; ° — � � <br /> i iJEi!S�= W(.lRf''� ).i�ici!=1-Lr, i . � <br /> ''�-Ef- CI1`Y = � r,Er_rs ( 1_I � <br /> .IriTFI'_L D�ATFF F.JXi 5 TO GF'(lLil: A l "fb.' � <br /> . �.. SU!+'E C�F� .�;��..�.i � .,... i ..,i ..- i i ., . _ . .... <br /> �r, r,i•I l i r � _ � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apUlicant hereby agrees to hotd and save harm- <br /> less the Ciry ol Everett Irom any ani all claims for damages. cosis. �' <br /> ��� expenses. or causas oi action Uiat may arise hecause of installation <br /> c J�C in w../�� a // 8 and maintenance ot �he improvement or other righPof�way use herr,tn <br /> ��—�u �� applied lor and further agrees to remove same upon no�ic� Irom Ih�= <br /> Approvci fnr Cons rut ction Date Ci�y and to repl,ce public propeny damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construded 5� n ture ol App ant Datr <br /> everetl PUBLIGb70RKSDEPARTMENT WORK AUTHORIZED RY THIS PERti11T MUST 8[ STARTED 6NITHIN <br /> � 3200CecarSireet 180 DAYS OF DATE PEFMIT IS ISSUE� AND THEREAFTER IS TO <br /> Evera'1,WA 9620: BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY �G <br /> Phana 259�t3B10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />