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� <br /> � � <br /> Date r /•�� 1 Q � pueiicWorkaaermit� �.�"��y _ <br /> ! <br /> Application For eido.oeuc a <br /> PUBLIC WORKS PERMIT PubTotelFaaF°° : ": <br /> LeesAppLFee"C $ <br /> Print or Type Only ea�a��eo�� s �S'0,00 <br /> � �►� �i S v S 1. 5���-7r4 t,1/(��1� — <br /> ,.+v'� - I L3 f,o Cs� e,f�T'^—^� - �?_� -i,3�u <br /> 1 �S�i� MailingAddress Cny Zip Ph^ne <br /> Lrt�ST ��W'"1�. Lk1 1/�'Z 4-L=� 79.}'�'SJ��-� �.�il,w —• : 1� y � (��\ 3Z'7 <br /> Applicant Mailin�Addre City .. �11a� -- <br /> Oesc :oe P-�pose-d Wnrk �U�!� �C/�) ('W i -�F �I !2%ll�l'�-Cf� <br /> l — <br /> I�IU�ec�Addressjlf �nown) � � ,`/V' \ !�.�/j---� C�Y -�_ - •;'�Or - - � <br /> Atlach four(4)copies of plans i�:proposed work• Draw to scale and note the Iollowing as applicable: � <br /> • Property Lines • Centerline of street /_ <br /> • putline and dimensior�s of all existing an� • Indicate North V� <br /> proposed structures on the lot � i Ch�:�em;prop�=cd graJluy changes <br /> • Existing and proposed utilitiea • Show measuremenis � <br /> �O NOT WRITE BELOW THIS LINE i <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance•Nith this permi� and current City of Everell Design and Construction <br /> Standards and Specifice�ions. <br /> 3. Call Location Underground Service 48 hrs. 6efore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> 5� F.QsErnF,c,iT To c'�E G.�"a.vTEU To %��F C.�'i f/ Oi� <br /> Ev�.eE"!T AT �[/O C.l1A,e�C' Fo� T.c�jQFFi� S/!i�/vL O <br /> �+'�G E An�o S,oE�u�c,C �,v �?e,va,-r f,'�a/�E.e�y. � <br /> -�`.- C'u2:3 r � V♦ <br /> � C UTiE.E: £ S'i /�/Q .0 T <br /> , � /-�c� G , b'�' C'oti'ST.c�:IC TE'L� <br /> PE.e APi�.eOliEO j''L.di✓S O4Tc0 / �-...'.�-5'S o <br /> 1 � <br /> s <br /> r <br /> ; <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Gity ol Everett irom any and all claims tor tlamages, cosis, <br /> expenses, or causes of action ihat may arise because of installation <br /> ��� ���' `o /� ys- and maintenance of the improvement or olher righl�ot-way use herelo <br /> � applied for and further agrees to ramove same upon notice �rom the ..� <br /> Approved for Construction � �a�e City and to replace public property damaged thereby. <br /> <���—�—�� � . <br /> IN PF.CTION Date W"�\ �} .-, <br /> � F:pproved as Constructed Sig ature of qppli nt Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TIiIS PEFMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSl1ED TO COM1IPLETION. THIS PERMIT A7AY BE <br /> 4„ Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />