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... 1 ,�� <br /> ��]{7��J- � ��"��� ��_ 29� <br /> Date�� Public Works Permi�v / <br /> eia�.o�ai.+ <br /> Application For _ <br /> P� B L!C VilO R KS P E R M I T PUoTo al Fee�eC 5 <br /> Lrs;APp�Fev Paid $ <br /> Balanco�uc $ ���O <br /> Print or Type Only <br /> �' <br /> � �m m�"S �'v�r�5f- ��21 �4a� �l�� .�—�tl�11 (,t 1/� q�� <br /> Uwner Mailing Address Cily Zip Plione <br /> �,s�p�rn.� — - <br /> Applicant Ma�ling Address City Zip Phone <br /> Describe Proposed Wurk _LJLdJ� �� t � ���� ����� �� �� <br /> u�� � <br /> Project Address(if known) �73� �`�r��'�~',- 'S'E � <br /> Attach tour(4` r.opies of plans for FroFosed work• Draw to scale and note the following as apPlicab'e: �� <br />� • t•,operry Lines . • Centerline of street � <br /> • Outline and dimensions ci all existii �and • Indicate North ;, <br /> proposed structures on the lol • Show any proposed gradin9 chanc�es 4 <br /> • Existing and proposed utilities • Show measuremenis M - <br /> W � <br /> DO�'7T WRITE BELOW ThiIS LINE O : <br /> PERMIT CONDITIONS <br /> t. All calls(or inspection shall be ma�e 24 hrs. in advance- phone 259-881 5. � � <br /> 2. .411 work shall be pe�formed in accordance with this permit and current Ciry of Everett Design and Construction <br /> Standards and Speciticalions. <br /> 3. Call Location UnJc��round Service 48 hrs.bef�re you dig.TOLL FREE NUMBER 1-800-424-5555. � ` <br /> �iNf/ ,cx,-r�/S�/i,� 1%GG D,tJ LOT Lf//GG ��C�U%�d` r <br /> O � <br /> f v9�iC Wo,e,fs .dF..��J.e.—��,�n/7 �ii;:�a✓AG. <br /> � . <br /> V/ <br /> O/� <br /> Y� <br /> ACKNOWLEDGEMENT OF CGNDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Cily ot EvereU from any and all claims for damages, costs, <br /> / expenses, or causes of action lhat may arise because of inslallation <br /> ° , C� /yL O 6 and main�Enance ol the improvemenl or olher right-of•way use nerelo <br /> Ij7Yy c� applied (or and further agrees to remove same upon notice from the <br /> Approved for Constru i n ate City and to r ¢lace pu6lic pro ty dama�ed ihereby. <br /> �` Z`�l�' - �-3. / <br /> _ � <br /> � q� 8 7 <br /> FIhAL !N3PE I N Date -L'�'u `�� <br /> Approved ae ConsL::cted <br /> Si paWreotA plicant D te <br /> ORK AUTHORIZED BY THIS PERMIT MUST BE START[D WITHIN <br /> everett PUBUC WORKS DEFARTMENT 7B0 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS 70 <br /> � 320C Cedar Slreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA1' BE <br /> Evereit WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> Phore: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />