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Date3 ����� <br />Applicatior. For <br />P���ic �nr���cs �ER,nniT <br />Print or Type Only <br />� <br />Owner <br />, <br />Pul�im Works Permil a '� f <br />v . 4: <br />o��d �,-�• > '�s// �s 99 - <br />PublicWorksFoo $ <br />Toial Fco <br />Less PppL Feo Pa�tl � o /' <br />❑aianco Dua ! c' � VC <br />f Sr2� <br />Phone <br />Mailing Address City Zip Phone <br />ppplicant <br />N;Ti1c� r�S' G`i�lD� LLINC�E7F_. ,�j/�`fUELL.� <br />Describe Proposed bVork � <br />Prolect Frdrass (if kno�vn) ��C� � � Z` � �� `� <br />Attach fo�r(4) copies of plans (oi propOsed work- Draw �o s�ale and note Iha }^Ilowing as apolicahie: <br />• Praperty Lines <br />• Outline and dimensior,s of all existing an� <br />proposed slrucWres or the lol <br />O Existiog and proposed utilities <br />• Gentr+rhne of siree� <br />• Indicate h?'�rth <br />• Show any proposed grading chany�s <br />• Show measurements <br />1� <br />PERMITCONDITIG.�S <br />1. All call, for inspeaion :,hali be made 24 hrs. in advance � phone 259-881 5. <br />2. All work shall be performed in accordance with this pennil and current City of Everett Gesign and Cons�ruction <br />Slandards and Specitic:.tions. <br />3. Call Location Underground Service �78 hrs. beforc you dig. TOLL FREE kUMBER 7•800•424•5555. <br />Approved lor :;onst <br />FIIJAL INSPECTION v <br />qpproved as Conshucled <br />everett PUBLIC WOR' S DEPARTMENT <br />� 32.,0 Cedar ° -et <br />Fverett, WA F 1 <br />Phonc�.259-Oo�5 <br />� _. <br />:�S c')� <br />Date <br />Date <br />i\GIWOVJLEDGEMENT OF CGNDITIOIJS <br />.: <br />The unPersigned owner/apPlicant hereby agrees to hold and save harm� <br />less Ili� City cf E�ereti from any and all claims �or damayes, costs, <br />expe�ses, or causes of action that may arse b=cause ot installation <br />and main;=nance of the improvement or other righFof�way use hereto <br />3pplied for and further agrees to remove same upon notice irom the <br />Ci ro repNce pu ic properry damaged thereby. <br />/ aG�_ <br />�Si ature o( APPIic- t Date <br />K AUTHORIZED �Y THIS PERMIT MUST BE STARTE� WITHIN <br />EODI�LIGENOTLY�PURSUED TOICOMPILE�TION.DTHHEPERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOFPAGE OF WORK ON THIS <br />PROJ[CT OVER 90 DAYS DURATION. <br />0 <br />-i <br />c� <br />m <br />.-� .� <br />-i � <br />.. .� <br />v� x <br />0 <br />m <br />c o <br />mo <br />�: <br />O 3 <br />m <br />-i z <br />x -{ <br />m <br />.c� z <br />c <br />a -+ <br />r x <br />�� <br />—i v <br />K T� <br />o z� <br />�s <br />--i m <br />x <br />m �- <br />0 <br />in <br />or <br />c� m <br />c cn <br />3 v <br />m <br />�n <br />=i r <br />� m <br />D <br />� <br />