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� ! <br />Datd�6 ,'i/r�r <br />qpplication For <br />PU�LlC V1/17��C� <br />P� int or Type Only <br />D:scribe Proposed Work <br />Pubf¢ Works Peimit • U,i � � � <br />B�E9. Deol. • �� <br />I publicWO�kiPoe $—�� <br />� ^ � � A i � rota� Fee <br />r IYItl <br />�ess noo�� fee ae�tl S�— <br />Be�ence Dua $ � —" <br />�a S° f <br />�C:� <br />Phone <br />Zip Phone <br />� ���..- <br />Prole�� �ddress (il known) <br />licable: <br />Attach tour (4) copies ot plans for proposed work - Drow to scale and nole e`e Itedine of streel <br />e � �'�e5 • Indicate North <br />a�'��P Y s Shcw any propo°ed grading channes <br />O Outllne and dimensions ct all existing and o Show measureme��ts <br />proposed stru fo��os d ulities <br />• Ezisting anA P P __ ��, ,.,,,,, Tui� i INE <br />8815. <br />pERM1T CONDITIONS � <br />erlormed in accordance with �his permit and current City of Everett Desi9n and Constructiori <br />1. All calls for inspection shall be made ?.4 hrs. in advance - phone 25 <br />Z, Ail work shall be P <br />Standards �nd Specifications. ou di TOLL FHEE NUMBER 1•800•424•555 • <br />�. Call Low!ion Underground Servlce �8 hrs. belorc y 9� <br />PUBLIC WORKS DEPARTMEN� <br />everett 3200 Cedar Street <br />�� [veretl. WA 932C1 <br />t Phona'.259�E1815 <br />ACKNO`r1LEDGEMENT OF CONDITIONS <br />T��, ,inderaic�nedowner/apP <br />licact hereUy agrees to hold and save `osts, <br />arise because ot insta�erelo <br />less Ihe Ciry o� E-aerell irom any and all claims lor dama9 <br />expenses. or causes ol actio�nVe�ae^ of other righ; of�way use <br />and maintenance of the imp <br />ypp�ied for and turthUblagpe�ePef°y�damaged here6yn nolice irom the <br />City a replace p <br />��� ��� /1���•7.,�(-� <br />(/ . <- <br />�y Date <br />g�9 l�re of ApPllcanl <br />THEREAfTER IS TO <br />RK AUTHORIZED BY':HIS PERMIT MUST BE STARTED WITHI <br />TO CO�APLETIGN. THIS PERN�T MAY 0� <br />80 DAYS OF DATE PE�`+11T IS ISSUED AN <br />I BE DILIGENTLY PURSUEU <br />DY 7FIE GITY UPOh l.P:Y STOPPf, ,E OFVJGFk ON Tf1iti <br />CANCELLED <br />PROJFCT OVflR 5� DFYS DUR%�T�O��� <br />