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i <br /> ; <br /> � <br /> � <br /> ; <br /> , <br /> � <br /> � �� <br /> D'dt@�' Z�-�� v��oi��wo,�sa�,m�i. __L_��_�1__ <br /> ei�fq Den� ,, I <br /> Apptication For Z VY7������� <br /> PUBLIC WORKS PERMIT PubbcYJor45F�� <br /> r�.i,i re� 5-�- - <br /> lessAncl FeepaN 5 <br /> Prirt or TYPe Only e.,�a��.,o�„ s �'��� --- <br /> ���+r �n�� �. ,�/O��i : 1��,�, �� ;l�) �i/���n ���c�l ��a�� <br /> 0�4ger Mailm57 Address City Lp Phone <br /> ���1�`�11�1J� `���7 ��-`�/�`�`_� <br /> " Applicant Mailing Address City Zip Phone <br /> Descri6e Proposed Work ��� ` ��� l �_��n7-��` �Li�<- ( 1 _ <br /> Prolect Address lil known) �/ ���� ', �/�����- ��l'�- � <br /> � <br /> Atlach four(4)copies ol plans for proposed work- Dra�+to scale and note the following as applicable: � <br /> • Property Lines • Cen!erline of street � <br /> • Outline and dimensions ol all existin�and • Indicate North <br /> proposed siruclures on the bt • Show any proposed grading change, <br /> • Existing and proposed utilities • Show measuremenis � <br /> CO NOT WRITF BELOW THIS LIN[ O <br />� PERMIT CONDITIONS <br />. 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.NII work shall be peAormed in accordance with this permil and current City of Everett Design and Construction <br /> Standards and Specificaf�:�s. <br /> 3.Caii Location Underground Service 48 hrs.before y�u dig.i�OLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> �w <br /> �V <br /> O <br /> � <br /> ACI(NOWLEDGEMENT OF CONDITIONS <br /> �� The undersi9ned ownedapplicant hcreby a9rees to hold and save h�rnr <br /> ° — —�-��-- less ihe City of Eoere�I Irom any and all claims lor damages. costs. <br /> j'. � . , , ezpense�, or causes of action ihat mTy anse because of installation <br /> /=�. � �) � ��; and maintenance ol �he improvemenl or other righl-ol-way use hereto <br /> �-- . /-._ <br /> —�—� ��� `" �- ' ' `a � applictl for and turther agrees lo remove same upon nolice lrom �he <br /> Approved for Construc iop �D le City and to replace public Uroperty dama�ed lhereby, <br /> ��`"j"��C/ �7" _.���� ^/ �� <br /> FINAL INSF'ECTION Date \ ' �1 � "}-- 3 � _ <br /> Approved as Construcied Si9na re 1 AGPhcanl aie <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PGRMR MUST BE STARTED WITHIN <br /> � 3200CedarSlree; 180 DAYS OF DAi�E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA9820� BE DIUGENTLY PURSUEL� TO COh'��LETION. THIS PERMIT MAY BE <br /> Phone:25�J�8610 CANCELLCD �Y THE CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> PROJECT OVER 90 DAYS CURATION. <br /> i <br />