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' /i`' Y� _ <br />f1a , <br />qpplication For <br />E�U��g� WQRK'S PEC�N�IT <br />Print or Type Only <br />Gt l_S <br />qpPiicai�'. <br />Descrioe Proposed Work <br />=.1..� c: <br />�ic��r� <br />� <br />� S E=��'i� <br />�ing Address <br />ling Addre <br />,�5 �G(l�� <br />�- <br />� +� <br />CitY Zip <br />l�V . <br />SS'Y^ I 5 � -- <br />Pot' c Y���ks Pemm = <br />eia9.oeo�.: �� �3J.��5 <br />PUM��c Wa�ksFeo S, �O, �`� �j <br />lolalFee � <br />Less AOPI. Fm Pa��d � --- <br />� afl. D C.----- <br />�a�anco oue __. __ <br />6� Y7 <br />�% j�1Gt� ;;�5��/�/i-`-- <br />Phone <br />Phone <br />v� .-�t�� <br />Project Address (if kno�vn) ' " — <br />Attach four �4) copies of plans (or proposed wod<- Draw to scale and note the following as applicable: <br />• Prop�rty .ines <br />m Outli e and dimensions of all existing and <br />proposed structures on lhe lot <br />� flities <br />• Centerline ot stree' <br />s Indicate North <br />O Show any proposed gratiinn chan�es <br />O Show measurements <br />O Existing and propose u i , <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT COt:D:TIONS <br />t. All cells for inspection shall be made 2a hrs. in advance - phone 259•$6� 5. <br />2. All v�ork shall be perlormed in accordance with Ihis permit and cu«ent City o( Ecerett Design and Cocstructicn <br />Standards and Speci�ications. <br />3. Call Lccation Underground Service 46 hrs. ueforr: you di�. TOLI. PREE NUMBER 1-800•424-5 . <br />� <br />,�-- �• . -� /�� %_ _ <br />�_� �/ r �c.Gr. � � - S - / l� - r�Y <br />Date <br />Approve r Co ction ^ <br />� g' 3-�`�- <br />Date <br />FINAL IN l �ON <br />Approved as Constr�cl <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. VJH 9P201 <br />Phone 259-8d15 <br />� <br />� <br />� <br />•� <br />ACI<NOWLEDGEt�1ENT OF COPIUITIONS <br />The under=_i9ned owner/apph�,...'+hereby agrces to hotd and save harm- <br />less the City of Evere�t froci an� and all claims tor damages, costs, <br />expenses, or causes of action lhet may arise because of installation <br />2nd maintenance of Ihe improvem�� �t or olher :ight�of-way use hereto <br />yp�p �ocl-Sor and (urther agrees !o remove same upon notice from lhe <br />City�and to replace pub11G property dama9ed thereby. <br />% <br />l�i��,�,,� ��-� �� ��=�s ����— <br />L' �, �; � , _. — Date <br />Sign re of Anplican <br />WOFlK AUTHORIZED BY 7HiS PERMIT MUST BE STARTED WIT�'ItJ <br />180 DAYS OF DATE PERMIT IS ISSUED AND �HEREAFTER IS TO <br />BE DILIGENTLY PURS! �ED TO COA4PLETION. THIS PERMIT MHY 2E <br />CANCELLEC B�i -i I-IE i:IT'f ll?ON f+`J'Y STOPPAGE OF 1h'OFK ON THIS <br />pROJECT OVER 90 DAVS DUH:.LON. <br />'s' <br />C. <br />C: <br />