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��� <br /> �ate���� � P�o�,�wo,�:PP���,�. �� �`— <br /> � - 2� <br /> ` eiaa.oeoi.,.____1r / _�� <br /> Application For <br /> PUBLI� WORKS PERIVIIT 'ubTololFeaFeo � -__ <br /> less A00���ee PaiE S /, <br /> BalanceDue 'J ���✓�- <br /> Print or Type Only <br /> �, ti� �, �9 —�-�s�� <br /> wner � Mailing Address City ZIP Phone <br /> ��=r�`-= — <br /> Applicant Mailing Address City Zip Phore <br /> DeScribe Proposed Work __ `� � � — � <br /> —_ �! � <br /> Project Address(it known) �-�"�� !� ���30 � �T ��'��'�� S,E � � <br /> Attach four(4)copies of plans for proposed work- Draw b acale and note the lollowing as applicable: �� <br /> � Property Lines • Centerline cf streel /�A <br /> • Outline and dimensions ol all existing and • Indicate North V� <br /> proposed struclures on the lot • Show any proposed grading changes <br /> • Exisling antl proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. A!I calls tor inspection shall he made 2a hrs. in advance- phor�e 2v9•k381 5. � <br /> 2. All work shall be performed in accord.nce with ihis permit and cwrenl Ci�y of Everett Design and Consnur.�ion <br /> Standards and Sp=citications. <br /> 3. Call Location Underground Service 48 hrs. betore you dig.TULL FREE NUMBER 1•800-424•5555. � <br /> 5! ,fE'�4,�c�' h'�vy .vs.r,9�f-o G!�, �;G-m--� � s�J � <br /> /E���F.oT Ci�'if' /,cJ Cv-�d - cJFs: E:✓� ��' !n/J <br /> � fIc.�G'cf%�s� T�E,��E� rp <br /> S U2�'OE' _/oT SO f,�S NoT"' 7� ..�:Nr'P.-'> T,vE \4� <br /> .S//.E'/ZOUND/N!f f�0/�r'2TG� !-L�iT�S' �'`���'��'��i= .--- � <br /> .�G�N�f=�: <br /> ,/�,, �o.virJ�'cT T� f?r/.�-' - .��?J S,�. (�/i'.r/<;' F.�.� !)nidrU=i'DU7, � <br /> ACKNOWLEDGEti'ENT OF CONDITIONS <br /> The undersigned owner/apGl�caM hereby�grees to hold and save harm- <br /> � less ihe City of Fverett Irom any and all claims tor damages. costs, <br /> � �� �//,' expenses, or causes o( action that may arise because of installetion <br /> (����y��,C,,� /./��/� and maintenance ol the improvemen� or oiher right-of�way use hereto <br /> 'y applied for and lurther a�uees to remove same upon noticr. Irom ihe <br /> Approved lor Construcl� Date Ciry and o replace public properly damaged Ihereby. <br /> ^ zfc ��� ' ( — � — S� <br /> PINAL INSPEC ION Date � . <br /> Approved as Cnn�tr�cled Si ure of App ican Da�e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MU � BE STARTED 1NiTHIN <br /> � 3200CedarStreel 140 DAYS OF DATE PEP.MIT IS :3SU AN �ffiEREAFTER IS TO <br /> EvPren,WA 98201 BE DILIGENTLY PURSUED TO COMPLE ON. �H;S PERPAIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOP �E UF V/ORk OIJ THIS <br /> PROJEGT OVER 90 DAYS DURATION. <br />