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.:.�_.--_ <br /> �B�B��..� .. .___..--_.__. .. Punec won.Pa . U/ V <br /> AppliCalion For Bma o.p� . �� <br /> PUBLIC WORKS PERMIT PO�1i°N^��+<<e --- <br /> totellee f____� <br /> l!a{�pP�i!!oup {� <br /> Print or 7ype Only B�iiance Due • ['L� <br /> lJ c ' C � c C��.� J <br /> nw^B ` Malling Address ���y � <br /> P Phona <br /> i I <br /> � i APPlicant Meiling Atldress Cit —' �`� —L I��� <br /> i Y z�P Phone <br /> y ���7 � <br /> DlDc�ibC Propoaed Work I �,�1 ��i{—Ilr� <br /> /OOB W <br /> Pro�ect Adtl�oae pl known� � — l�j�/Gl,E l� � <br /> Attach four(4)copies ol plans lor proposed work• Draw lo scole and no:e the following as appllcebie� <br /> � Proparty Llne� • Centerline ol street — <br /> •Outline end dimeneions ol all a�isting antl • Indicale North � <br /> propoeed slructure6 on the lot • Shovr any proposed gretling chanpea <br /> • E■Istinp and propwed utilitlea • Show measurer�ents <br /> O N T WRI E BEl W THIS LINE � � <br /> PERMIT CONDITION3 O <br /> 1.All calls for Inapacllon ehall be mede 24 hra.In advance•phone 2b9�8810. <br /> 2.All work ehsll be peAormed In eccordence wlth thia permil end currRnl Clty ol Eve�ett Deelgn and Conshuctlen ' ,� <br /> Standerds and Speciflcatlons. <br /> 3.Call Locallon Underground Service 48 hrs.belore you dig.TOLL FREE NUMlEX 7•800-�{Q4•56aa. <br /> / �__ . x <br /> .�� . O <br /> ;� \. � �" I- \��, � <br /> 4/ � <br /> �� �� � <br /> � .� a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apphcant hereby egrees to holtl end save herm• <br /> less �he Cdy ol Everatl Irom any and ell cleims lor Aomages, costs. <br /> ` e�penses, or causes of ac�ion Ihat may arise because o� Inatallation <br /> � / ,.t,l�_ ���`j S� and maintenance ol ihe improvemqnl m othar riph�•pl-way uee herelo <br /> ApP�oved lor on � on applied lor and furthu� agreos to �emove same upon notice Irom Ihe <br /> Dale City anJ to replace pubhc e�ty damaged thereby. <br /> � <br /> - FINAL INSPE TION Date �/Q � p /� <br /> Approved as ConstructeJ Sig atu ol pplicant <br /> Data <br /> everelt PUBLICWORKSDEPARTMENT W RK U HORI2ED BY S pERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStraet 1B0 �AYS OF DATE P .�1T IS ISSUED AND THEREAFTEFi IS TO <br /> Everett WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:258�BB10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br /> ! <br />