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._ <br /> �8�6�8 / �^ ��` PuOuc Wod�PumOI <br /> Appllcetlon For emp.oeu�..� <br /> PUBLIC WORKS PERMIT °°°,o:F::F°. : <br /> Leu A00�Fae PaIA S <br /> Print or Type Only e.�.��.o�. s <br /> ,�irr��-G2�Tc�1�1 SNAFFfQ &)� Al�)!�1�d2 �tJ�T" �58- � ��,5 <br /> Owner Melllnp Addresa Clty 21p Phone <br /> �'�})')'1� <br /> Appllcant Melling Addresa Clty Zip Phone <br /> Descrlbe P�oposed Work ..-�11�- ]��( .YL 1 <br /> . W <br /> Pro�ect Addross(If known) �Y� � <br /> Aft�ch lour(4)coples of plane for propoeed work-Draw to ecale and note the lollowiny ae applicable: � <br /> • Propsrty Llneu •Centerllne of slreet � <br /> • Outline end dimenalons ol all exletinp and • Indicate North <br /> propo�ed�tructuree on rhe lot • Show any proposed predinp chengee <br /> • Exletinp end proDoeed ulllltlee • Show meeeuremente � <br /> L OPERMIT CONDITIONS <br /> 1. All cell�lor Inepect�on ehell be mede 24 h�a In edvence•phone Zb9•�16. � <br /> 2. All work ah�ll be perlormed In accardance with thie permlt and current City ol Everett Deelpn end Constructlon <br /> Standerda�nd Specll�catlona <br /> 3. Call Loc�tlon Underyround 9ervice 48 hra before you dig.TOLL FIIEE NUM�ER 1•d00•4Z4•6666. � <br /> �%ir5'!�•C �c/oR.�s' /�E.e�> itlOT �'E9v�,eF'o '��i� � O <br /> s <br /> ��i <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEOG[MENT OF CONDITIONS <br /> 7he underalqned owner/applicant hereby apreea to hold end save herm• <br /> lesa ihe City ol f�e�ett hom any end ell clalme for demape0. coa10. <br /> expenses, or cauaee of ectlon thet may arlse beceuse of Inetallatlon <br /> and meintenance of the Improvement or olher right•ol-way uae hereto <br /> applied for end lurther egreea to remove eame upon notice Irom Iha <br /> Approved lor Conalructlan Dete Clly and to replaca public property dameped thereby. <br /> FINAL INSPECTION Date <br /> Approved es Conatructed Signeture of Appllcent Data <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2E0 BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURf,UED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone•259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � PROJECT UVER 90 DAYS DUHATION. <br />