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� <br /> i <br /> ��� �;� // <br /> Dale_l�� � ��,e���wo,k�v��m���.2C� / � <br /> Applicatinn For ��ne oepi.. ._1�/�.'�LJ./---- <br /> f -_ <br /> PUBLIC WORK� PERMt�' �°°��°W°�°s�°�-- <br /> ,�„�F�� s_ _ <br /> �ress Apn�-Fer Vai�.1 S __ <br /> ��i <br /> BllanCe Dur $ ���—' <br /> Print or Type Only -- <br /> �� ��InV l�L�� C��IrL u � �1�i�� , � q�4C�7 l�'7,Q- ,�.�/�,�� <br /> / Owner 1 Mailing Atldress City 7_ip Phone <br /> �'l�11('�`�Df1'�''� '7l� ��_�—�—"►'�l� .��� l,(� _��#� , .�C7��o�J <br /> Applicant � Mailing Address City � Zip Phone <br /> Describe Proposed Work ��—!� . <br /> c� __ � <br /> Pwject Address lit known� U��'S' /� thv? SC� � <br /> Attach four(4� copies of plans fur proposed work- Drav� to scale and note ihe following as applicable: � <br /> • Property Lines • Centerline of street '^ <br /> • Outline antl dimensions ol all axisting and • Indicate Norih V� <br /> proposetl structures on the Ict O Show any proposed yraAing changes <br /> 1` Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BLLOW TH13 LINE O <br /> FEFr.71T CONDITIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pertormed in�ccordance with this permit and wrrent City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Ca" Location Underground Service 48 hrs.be(ore you di�.TOIL FREE NUMBER 1•S00•424•5555. � <br /> O <br /> �w <br /> �/ <br /> � <br /> � <br /> ACKNOWL[DGEMENT OF CONDITIONS <br /> �i n�� undec;igned ownedappliCan�hereby agrees to hold and save harm- <br /> � , , <br /> � less Ihe� Gty ol Everet� Irom any and ail claims for damages, cosis, <br /> %�3� j /�J , expenses, or causes ol action that may arise because o( installation <br /> -(� „ �y �� and maintenance ol Ihe improvement or other right-of�way use herelo <br /> '�� �C' �� / /�r�/ appfied for and further agrees to remove same upon notice from the <br /> Approved r Constructi n Date City and to replace Uublic property damaged thereby. <br /> � � i i <br /> ' f —�-�- (� -J —/ S -.D ,? <br /> FINAL INSPECTI � ' Date " — <br /> Approved as Constructed Si9naWre of Applica D�te <br /> e�'��mtt PUBLICWORKSDEPARTMENT WORK AUTHORI BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF DATE PEP.MIT IS ISSUED AND THEREAFTER IS TO ( <br /> Everett,lh'A 9A201 BE DIUGENTLY PURSUED TO C� MPIETION. THIS PERMIT MAY BE <br /> ��I phonc:159-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � I PROJECT OVER 90 DAYS DURATION. <br />