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r_r � <br /> Dete 7 .Y�r r � PUGim Won�P�rm�• <br /> Application For eiao oeo� � ��'�� <br /> PUBLIC WORKS PERMIT °°°��W°.�°`°° - <br /> Tot�l Fee :— <br /> Lea�Appl qe Fa�a j— <br /> 6eimro Due f <br /> Print or Type Only <br />� s.,�'—r��� a�,►rf ?,� l�i�,�r�� ��� �-�` , ��<�.�-��-�' ��< <�-�r�� �� ��' -'��� 1 <br /> Ownor Meil�ng Address CiIY Zip Phone <br /> �, � �, � -, n -� , � � i� �, � .-. �,- _,i � <br /> lt ' ...��� f`'I �/���, ��-�'-f .�n��r-��q �' _ . inl�_r,� I'��,� ��1,� � < ._ , ,�,��, <br /> A licent Meiling Addrnss C�ry Lp Ph�nx <br /> PP <br /> _i� J,/-1 l�'�ll �y.�� �- .�, �A'I�`; � ! .1�':�-- <br /> eacribe P/o osod Work <br /> . . i u <br /> � / -- LIJ <br /> Pro�ect Addreee lil knownl _� �–� I.� — � <br /> Allech lour(4)copies ol p�ana for propcaed wu�k� Drew to scole end note Ihe lollowing as ap0��cable: � <br /> • Property Linee • Cenlerline ol street � <br />' • Outline and Eimeneions ol all e�is�ing and • Indicete Norih <br /> propoeed etructu�ea on the lot • Show any pioposetl gradmg cnanges <br />� • Fxlating end proposed uNlities • Show meesuraments � <br /> DO NOT WRITE BELOW THIS LINE O <br />� PERMITCONDITIONu <br /> 1.All calle for Inapectlon ehnll be ma�fe 24 hrs.in advenc?-phone 259•8810. � <br /> 2.hll work eball ba pedormed in acwrtlance with this permit and current Ciry ol Everetl Design and Conslruction <br /> Stenderds end Spocificatlona. <br /> 3.Cell Location Undei{pround Service 48 hre.belore you dlp.TOLL P EE NUMBER 1•800•424•5555. � <br /> r�t'f � «'-:� '1 (�� <br /> A <br /> ���� ��� F- <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEME.NT OF CONDITIONS <br /> The undarsigned owner/appGceM hereby egrees lo hold antl save herm- <br /> — less Ihe Gity ol Everett Iwm any and ell clalms lor dameges, coeta <br /> e�penses. or cau6e5 0� c�!iun ihat may arise hecnuse ol installation <br /> and meintenance of ihe improvement nr other nghlro��way use hereto <br /> . eppGed lor and furiher agrees to remove seme upon nolica from tha <br /> ADProved lor Constr•�clion Date City and to replace pubhc prope�ty dameped thereby <br /> FINAL INSPECTION Dete - <br /> Approved aa Conatrucled Sipnature of Appl�canl Date <br /> WORK AUTHORIZED BV THIS PERMIT MUST 13E STARTED WITHIN <br /> everelt PUBLICWORKSDEPARTMENT 1B� DAVS OF DATE PEFMIT IS ISSUED AND THEREAFTFR IS t0 <br /> � 3200 GeCer SUnet !)E DILIGENTL'I PURSUE� TO COMPLETION. THIS PERMIT MAY BE <br /> Evere�i.WA 9B:01 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone.259-BB10 PROJECT OVER 90 DAVS DURAIION <br />