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Uate 7� .� 1.SS��� = <br /> Vu01s Waiks Permit c � <br /> ApplicationFor eiag.oea�.> � �Sd7iY <br /> PUBL.IC WORKS PERMiT ��1��� PublicWorksFee __�q <br /> To1al Fea S_ ��/ <br /> ���� LessAOo�Fee Pala $ <br /> L <br /> Print or Type Only ���,���o�a s_ Z^�i^/ <br /> 5�� pss� 275o NonTuuP wAY gEu.EvuE 98op4 �-� <br /> Owner Mailing Address Gity Zip Phone <br /> �ww.�es n�o�ra � �roe �3a 8e�n.w uer �aerrr 982p3 3ss-2La$ <br /> Applicant Mailing Address Gry Zip Phone <br /> Descri6e Proposed Work _� A �I�V �C8 VA117 /}P4LTMt�� <br /> Projecl Address(i(known) 77�.7 � / � �� � <br /> Attach four(4) copies ol plans for proposed work- Draw ro scale and note'he following as appl�cabla: � <br /> � <br /> • Property Lines O Centerline of street � <br /> • Jutline and dimensions of all existing and • Indicate North <br /> propo�ed structures on the loi • Show any proposed �rading changes <br /> b Existing and proposed utiliues • Show measuremenis <br /> DO NOT WRITE �ELOW THIS LINE m <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hr,. in advance- phone 259•881 5. <br /> 2. All work shall be performed in accordance with this pr:rmit and current City of Evereit Design and Construction � <br /> Standards and Specifications. <br /> 3. Call Location Underground Seriice 48 hrs. before you dig.TOLL FREE NUMBER 1-$00-424-5555. <br /> / / <br /> � ,��,� ����p�,.,�c��'��%�.._ y': Z <br /> � <br /> r <br /> . � �� (/� <br /> �S'. �3 u��,Y,,l!-� � o <br /> s p_ <br /> �w n �� <br /> ACKNO'.NLEDGEMENT OF CONDITIONS <br /> The undersigned uwner/applicant hereby agrees to hold and save I�.ann- <br /> less Ihe City of Everell Irom any and all claims for damac�es, cos�s, <br /> / � i <br /> �%/_/, ` expenses, or causes of action that may arise because of installation <br /> �� ,�� / _��'—y9�t and maintenance of ihe improvement or other rigM-of-way use hereto <br /> A proved foi Con"structibn pa�e �pplied for and further agrees to remove same upon � g from the <br /> ( � Ciry;'pd,lp re e public proper age ihG b . <br /> ���/ ` yr��r1 �r <br /> /_ � � yb ♦ � <br /> FIN SPECiION Date � <br /> Approved as Cons�ruc�ed Signature of App icaM D te <br /> evemt[ �U�LIC WOFKS GEPARTMENT WORK AUTHORIZED BY THIS PERMI N, S BE STAR ED WITHIN <br /> �� 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUEO D T�IEREAFTER IS TO <br /> Everett.WA 9R201 BE DILIGENTLY PURSUED i0 COMPLETION. TNIS PERMIT MAY BE <br /> Phone: 259-861.ri CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAY3 DURR�ION. <br />