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� n <br /> Date � _ ���� t�7�/U�� � <br /> Publi�Works Permil n <br /> Application For pldq.Depl.a�_�_�C�� <br /> PUB�IG Vi/ORKS PERMIT PubTu��FceFce S <br />� LessAppL Fec Pa'itl S_.. <br /> Print or Type Only e�iao��u�� S�_U��— <br /> C'rC�Ci�'1 N-v»�- " ��i� S r �Ei' � r}v-icL t,c�U �I��a�-/ ,5�— ov <br /> Owner Mailing Address — <br /> C�ry ZiP Phone: <br /> r � y�� (/ <br /> Applic�nt Mailing Address �;i� <br /> Y Zip Phorie <br /> � <br /> Descrbe Proposed Vlork ��� I,l � �/-� <br /> Prolect Address(if known) J 7��– ��J�--/,(�,�? •.S'� / � <br /> �r�T 2z �n.�! :rs � <br /> Attach four(4) copies ot plans foi proposed work� Drew to scale and note the following as applicable: <br /> • Property Lines o <br /> • Outline and dimensions of all existin and �� Centerline of street I_ <br /> 9 U Indicate North v+ <br /> proposed structures on the lot !� Show any proposed grading changes <br /> o Existing and propused utilities �� Show measurements <br /> DO NOT WRITE BELOW THIS LINE m <br /> PERMIT CONDITIONS o <br /> t. All calls lor inspection shall be made 24 hrs. in �dvance- phone 259-881 5. <br /> 2. All work shall be performed in accordance with !his permil and curreN City of Everett Design and Consiruction � <br /> Star.dards and Specifications. <br /> 3. Call Location Underpround Service 48 hrs. before you dig. TOL�FRFE NUMBER 1-800-424•5555. <br /> � <br /> 0 <br /> � <br /> � <br /> � <br /> � <br /> ���� <br /> � ACKNOWL[DGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all ciaims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> ��(/z� pa��;__==_�5� and maintenance of the improvement or other right-oFway use nereto <br /> Approved for Co clion applied for and further agrees to remove same upon notice from the <br /> . / <br /> Date City and to replace Fublic properry damaged thereby. <br /> FINAL IhS ECTION / ' // //���a e �:�–�.�� `/' <br /> Approved as Cor.s;ructed � � n�a(ure of Flpplic t/ � � - / ` � ^ <br /> Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHQR� D BY THIS PE�MIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF' �OATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA g8201 BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br /> Phone: 259-881 5 CANCELLED BY THE CITY UPON ANY STOPPAGE� JF WORK ON THIS <br /> PR��'JECT OV[R 90 DAYS DURATION. <br />