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r <br /> Date$-2-ti 3 PuPI,cWPrL.Parml• 03 5 <br /> Application For aid,01W <br /> PUBLIC WORKS PERMIT °;o„°;:r- : moo <br /> Los.APPI Poe Pero <br /> Balance pv1 • .� 0�_ <br /> Print or Type Only /' / coq a8b9 1 <br /> Owner Maning Address City Zip Phone <br /> n.n-1 <br /> Applicant Meiling Address City Zip Phone <br /> tk <br /> Describe Proposed Work S 754�/ 7 f7rit, U_,'dr <br /> W <br /> Project Add ess(if known) % J v s �r G' <br /> Attach four(4)copies of plans for.rroposed work• Draw to scale and note the following as applicable: Missile <br /> • Property Lines •Centerline or street ♦^ <br /> • Outline and dimensions of all existing and • Indicate North v, <br /> Proposed structures on Iha lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /aA <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for Inepec ion shall be made 24 hr&in advance• phone 259.8815. tft� <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Sgecllleatlons. <br /> 1. Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800.424.5555. <br /> ca” . c-lveA4 firs ncrYt• Jr•Y e....1, 1•. cL4A 47(0w1'-t <br /> A� Le. LL.�l \NN/\.% Y.Y. CM1�CI+� IINI 414- <br /> IN Fp 1 •TI� IN` 1�It�" �r.J IN ` <br /> J Gf <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agr9es to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costa <br /> expenses, or causes of action that may arise cecause of Inotallation <br /> s•f`.� — and maintenance of the improvement or other right-of-way use hereto <br /> to rs ruction (�- Dale applied for and further agrees to remove same upun notice from the <br /> A pro <br /> _ CilI,and to replace public property damaged thereby. <br /> L FIN I SP CTION � —_ J <br /> Approved as Constru ed Slgnaluraof App at Date <br /> WORK AUTH� 3 BY THIS PERMIT MUST BE STARTED WITHIN <br /> everelt PUBLIC DEPART ENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLET 10N. THIS PERMIT MAY 8E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259.8815 PROJECT OVER 90 DAYS DURATION. <br /> L v <br /> L <br /> J <br />