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_....._.----- <br /> Date �! 3G + P�WiCWwM�P�rmN. T86--S/S7 <br /> Application For ewa n.m.._ n %Z/ �� [� <br /> PUBLIC WORKS PERMIT h°��W°^�°- <br /> Tau r« s <br /> - Lw Appl FM P�M S <br /> P�int or Type Only <br /> :�� �'OSTiNIG �Fr� �•M•o�• : ��— <br /> BCF�t�R t sows �►.c. �►z4 �39�' P�• s.e. 6otkeil wn• 98o�z 7ys-83�� <br /> Owner MsiNng Addreaa City Zip Phone <br /> SA mE <br /> Applicant Mai�ing Address City Zip Phona <br /> Describe Propased WorK $I F T(EW IZESi OCNeE �'O b�' 6�L1�'F <br /> �o�os - W <br /> ProjectAddress(ifknown) � AVE S.t• tVEQE� � �/O WES'f'GREEk DIVa � <br /> Attach t�ur(4)copiea of plans lar p�oDosed work-Drew to scale and note the foltowinq as applicable: � <br /> � PropeAy Linqs � Centerline oi street � <br /> • Outline and dimensions ot all exislinq and • Indicate North <br /> proposed struatures on the lot • Show any propoaed preding changes <br /> • Existing and proposed utiliHes • � • Show meaaurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspectlon shall be mede 24 hrs in advance- phone 259-8815. ' � <br /> 2. All work shall be perfarmed in accordance with thia permit and current City of Everett Deaiqn and Construction <br /> Sta�dards and Specificalions <br /> � 3. Call Location Underqround Service 48 hra before you dig.TOLL FFIEE NUMBER 1•800�424•5555. � <br /> 7'�. �B�iol� G7eG.�lti•G taEB,�z�s �,a�+� La7;l�O��' f�i1H of�' <br /> o.uro Aoro..v�.✓d P�OPE.eTj/ O <br /> S, /i/.9�G,y Fo�e /YJA�/if'oGE Fqr»E Co�,eEc� �uiry Di,eT � <br /> aEyinlD C/7y SiOEN�L,C . Ty� A�PG iGRA/7� WiIC � N <br /> �ESPONCidGE i�oR fjL✓y D9mqGE Ta /r O <br /> �D. S�QEWi✓G�C t' L�ivEcJ9y H4� .UEc� �' tl�v09in5YrE�. `i <br /> T�E f�PPci�,gnrT W/6L dE �P�SPe.ctig,E Fae .PE�[.Rei�,G- <br /> �.tlf/ i�v9T /S t�A..�Ab�.O 1,Yi.ei.vG- CGxJSY,e(/�'Tio� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underoigned owner/applicar�t�'�rehy agrees to hold and save ha�m- <br /> less Ihe City of Everett from a��� .nd ail claims for damages, wsta <br /> . � n expenses, or causes of action thai may arise because of installation <br /> ��`�i_ �� � and maintenance ot the improvenient or other right-oi•way use hereto <br /> applied lor and further agrees to remove sama upon notice Irom the <br /> pprovetl lor Con uction ata City and to replace public property damaqed t�ereby. <br /> ppAov d asE:,ons�t ucted Date gignalure of Appllcan�� ��, Date <br /> everett PUBLIC WORK5 DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAVS OF DATE PERMIT 15 ISSUED AND THEREAFTER iS TO <br /> BE DILIGENTLY PUHSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98207 CANCELI.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8875 PROJECT OVER 90 DAYS DURATION. <br /> i � <br />