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� <br />�: <br /> s, ; <br />,; <br /> Gate��� Publm Wo�ks ParmB+ <br /> Application For eia� oeoi.y� Z �b <br /> PUBLIC WORKS PEFiMLT �°°°°W°�k=F�� <br /> ,o������ s <br /> Le55 Appl.FCC Pdi� S <br /> B�IdlICC�IIL• S <br /> Print or Type Only — <br /> �"/� ��tN� n� ��?c[cl ,�_ L�t�`,��i_ �� ,�vP.iA7J� �i�'Zt�� � 3L�� <br /> �vmer �—Mai6ng Address City Zip Phone <br /> �� �� <br /> � Applicant Mailin�Address Clty Zip Phone <br /> Describe Proposed Work _�� '77`f .�(��(�ClC <br /> Project Address(J known) ! ��/Z— �� nl F� .S � <br /> � <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and no�e the follo�ving as applicable: � <br /> • Property Lines • Centerline of sireet PA <br /> • Outline and dimensions of all existing and • Indicate Norih �d <br /> proposed strucWres on the lo! • Show any proposed grading changes <br /> • Existing and proposed utiiities v Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calis for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shali be pedormed in accordance with this permil and current Ciry of Everett Design and ConsVuction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig TOLL FREE NUMBER 1-800•424-5555- � <br /> f//�J ��im-�� .�I'�o-�` /�$,v�rn.=� ��a,� � <br /> 3 22-�B L <br /> r <br /> V♦ ',� <br /> � <br /> � <br /> �CIVJOWLEDGEPALNT OF CONDITIONS <br /> The under.;igned ownedapplicaN hereby ac�rees to hold antl save harm- <br /> Iess the QIy ol Everetl from any and all claims lor damages, costs. <br /> cxpenses, or causes ol ar.tion ihat may arise because ol installation <br /> and main�enance ol �he improvement or other right-of-way use hereto <br /> applied for and lurther agrees to remove same upon notice Irom ihe <br /> Approved for Con;truction D:ve Ci�y and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed SignaWre of Applicant D2tc <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EverciC WH9�201 aE DILIGENTLY PURSUED TO ��MPLETION. THIS PERMIT MAY 6[ <br /> Phcne� 259-8F310 CANCELLED CiY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECTOVER JO D�YS DURATION. <br />