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�-y � <br /> , � <br /> Date—f"c� "v � ��,����� v��,..���, +�g�9�–���.9�- <br /> NnP���.liien For i�����i oem � CJ_ .�caSL7/(P�� <br /> PUBLIC WORKS PERMIT ����°-��,���,�--- - <br /> «,,,,���. s _ <br /> i res anni v...vx�a S_ __ <br /> PrintorTypeOnly Ea�.,���n�,. s_�n�__ <br /> ���1 YL ��' 1Lk�Y� �',2.lnln �V�L�. �,r� �l� � a� -��� <br /> Owne� Maihr.y Atldress CAy Zip Phone <br /> �i I� <br /> qppl��anl Mailing Address Ci�y :ip Phone <br /> DescnDe ProposeJ Work �`-��--��C - . <br /> Pro7ecl Addres5l��knownl _ �I�---�/ 1�-��/� � <br /> Attach lour 141 copies o�p�ans fa proposr.d work � Draw lo swle antl note the lollowing as anPl�cabie. � <br /> • Property LineS • Cenlerhne of SVeet � <br /> • Outiine and dimenslons ol all ezisting and • Indicate Norih <br /> proposed siruclures on Ihe lol • Show any propnsed y:atliny changes <br /> • EMishny and prOposod u�iLties • Shnw measuremenlc � <br /> DO NOT WFITE BELOW THIS LINE <br /> PERMIT CONDiTIUNS O <br /> 1.All Ca116 lor inspeC�ion shall be m&de 24 hrs.in edvanca•phone 2S9•$$��. � <br /> 2.All wmk shall be pedormed in accordance with Ihis pormit and current City ol Everett D?sign and Consiruction <br /> Stenderda end Specilicalions. <br /> 3.Cell Location Underground Service 4B hr5. helorn you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> � ' <br /> � <br /> O <br /> a <br /> \\] PCKNOWLEDGEMENT OF CONDITIONS <br /> , /- The undersiyned owner/apphcant hereby ag�ees to hold and save harm� <br /> less thr. Gty ol Everett Iwm any and all clalms lo� damages, cosls. <br /> —// / rxpenses, or causes of action Ihat may arise because ol installation <br /> e D!'� ! �� B��/ �n and mnintenance ol the nnprovemen� o� other nghl�obway use hereto <br /> 7 .Y �O �- 7 applieA lor and �urlher ac,7rees lo remove same upon notice Irom the <br /> Approved for Gons cti� Date City and Io �eplace pubhc propeity damaged thereby. <br /> -�`� � �yv- yo - 2 y-�'9 <br /> FI AL �NSF'ECTION Date <br /> ApproveA as Constructed nalure ol Appl c nt Dale <br /> everetl PUBLICWORKSOEPARTMENT WORK AUTHOR12E0 BY THIS PERMIi MUST BE STARTED WITHIN <br />� � 3200CeAarSVee1 I80 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone-.:59�8810 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> P(70JfCT OVER 90 DAVS DURATION <br />