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�8te�/p ' Pub��c WarM V�rmil� �7 �� <br /> Application For emo.oen�.•_�+ <br /> PUBLIC WORKS PERMIT �+���eWorbFu <br /> Tol�l Fea S— <br /> 4e��p0�Fsa P�iA s_.�_ <br /> Print or Type Only B�lence 11ue • �d� <br /> 1err� D�;� � 7z I ��,,� o _ E�pin /-f 4h'Ta/ az sh`-�l 74 <br /> Ow er a p AdOress City Z�p Ph ne <br /> ___1n wl • -- <br /> Applk��t Meiling Address City Zlp phone <br /> D��CNbs PrOPosaA Wo�k Crn�.��r..c 1�' ��i°-��-�u1!�G n w i+�I hnra e ��o <br /> ►'�ILupCI �tLf��� <br /> Mol�t AAdns��1I known� -'`�(p � ��/P!rc rt �a��lSyiQ��_ � <br /> Afl�ch lour(4)CopN�of plans lot propoeed work• Drew to scale and note Ihe lollowlnp a��appllcable: � <br /> •ProMrty Lines , • Centedina cf elreet � <br /> �Outllnl�nd dimemlone of�II eaislinp end • Indlcete North <br /> propowd�tructwes on the lot • Show any propoeed pradinp chanpee <br /> � Eal�tlnp�nd pro0osed utllitlea • Show meaeuremante � <br /> 9` I L I L O <br /> f I PF.RMIT CONDITIONS <br /> ' � 1. All cdl�lor inepectlon ahall be made 24 h�e in edvance•phone ZS9•881 b. � <br /> �'� � P. All work�hdl be parlormed In accordence wIM thle permit end current Clty ol Everett Deelpn end Conelruct�on <br /> ; I 8t�nd�rd�md Speclllc�tlons <br /> 3. Ce'I:�c�ticn U�derpround Service 4B hrx belore you d�p.TOLL FREE NUMBER 1•800�424•358a. � <br /> i <br /> fl O�� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLED6EMEN?OF COA'DITIONS <br /> The underaipned o.vner/appllcent hereby aprees to hold end save harm• <br /> lesa the Clty ot Everett Irom any and all clalrt�e lor demape0. coels, <br /> �'9��(.G[4DH�0l�.� �j/9/g7 exPensea or causee of actlon that may arlse becauee ol Inetallatlon <br /> end malntanance ol the Improvement ar other ri5�h1•of•way uee hereto <br /> epplled for and lurther agreee to remove sema upon nolice Irom the <br /> ApD�oveO lor ConaL/�� Dale City end t replace public property demaped thereuy. <br /> G-1 -F` � ? 9 8'I <br /> FINAL INSPECTION Dete <br /> � Approved�s Conetrucled SI t +ol pl cant Date <br /> �� PUBLIC WORKS DEPAflTMENT K AU R12ED BY THIS PERMIT MUST BE S��ARTED WITHIN <br /> � 3200Cedu3trael /80 DAYS OF DATE PEHMIT IS ISSUED AND TME{1EAFTER IB TO <br /> Everel�,WA 88201 BE DILI(3ENTLY PURSUED TO COMPLETION.THIS PcRM1T MAV BE <br /> Phone:269•�iB15 CANCELLED BV THE CITV UPON ANY STOPPAGE OF V/ORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />