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F <br /> �� � M . <br /> � � <br /> A � v 9 <br /> H� � �/� �f PuLp'WC'Y.Pw �'I Il . <br /> Date � (. ��(^�'�� <br /> � y� APPlicalion Foti sing o�ni • � ��aiL—J- . . _ i ! � <br /> � " � PUBLIC WORK� PERMIT �-�{' <br /> Pinicwo�afee v.�. f{ I <br /> VJ N r , ��rc 5—_ _ Sfy'. �.. <br /> z te.sAn- fn� Pa� 5— N �I, 'K <br /> O � <br /> � �� � �,�, � „ S o__ __ �k��t�:. <br /> O F.y Print or Type Onlv a � � " <br /> �✓�7 , <br /> � � g � � � , � <br /> c�• o � � � ,��" <br /> zH ���-r._ l7nrrvtnri � Sa..��� Cfi�iic /1/ SF_ ,Fvc�rf�/l��// ..G..i �,� `-; <br /> .�y y�, Uwner Mailing N�rel.� .. Cay Zip Phrn �' `}�. <br /> t-� o � i� ���. <br /> H H .-. o � �a . , . <br /> gN <br /> d� _�pvp }l�wsu;,� �ue��, �,w� �lGS�l�li/�a�l� l�r �vaia/-� y�Po3 �'�``f'zFSO <br /> �L+ � Apphcant Mailin9 Addiess City ZiP Phone <br /> CC / � <br /> Z H fA _�S�GLLC���LY-l1'1LL n �� �' � <br /> H O V� Descnb�� I�roaosedlVork w/C{qJ_ �� � """' '4m:�-�L ,l��i�>% _ <br /> �CN !"J — <br /> � <br /> --- W <br /> ProiectAddressUlknown) /�� ` R.Pr.t/ilc/�e��� f�L. ' � <br /> Attach lour I41 copies ol plans lor proposr.d work- Draw In scale antl note Ihe following as applicable: � <br /> • Property Linns • Cenlerline ot slreet � <br /> • Omline and tlimensions of all nxishn9 and • Indicate North <br /> proposetl slruc�ure: on�he Ioi • Show any proposed gradin9[��an9es , <br /> • Existing and proposed utilRies • Show meaaurements (� <br /> DO NOT WRITE BELOW THIS LINE � <br /> I \ <br /> i PERMITCONDITIONS <br /> I ��•i 1.All calls for inspeclion shall he matle 24 hrs.in advance-phone 259•8810. � <br /> � � � 2.All work shall be pedormetl in accordance with this permit and current City of Everett Design and Consimr.tion <br /> 1 Standards and Specilications. <br /> '+_ 3.Call Location Underground Service 48 hrs.before you tlig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � ��� `` <br /> [/ � �^ I'�' [� �� � <br /> I /, .tc'�-r�az��v' �Cc� .CJU.Z.Cl�J Cvrz�� Sl�i!<.��� c�n{ <br /> ,c. / <br /> J .l�:.'(�� �u.`�c.'`'-y CL�1htr� � 'C<CC� 5�7�%�«��: �' �i._iC-J � <br /> � �� .1 ,. <br /> V♦ <br /> `�r O <br /> a <br /> I ' 1 ' � ACKNOWLEDGEMENT OF CONDITIONS <br /> �i The undersigned owner/applicant hereby agrees lo hold anA save harm� <br /> � _� less Ihe Cdy of Evcrelt Irom any and all daims lor dama9es, cos;s. <br /> / expenses, or causes of action that may arise because ol installalien <br /> �✓'/ /�C� /� 5�� and mamlenance ol �hr. improvement Or o�her right�ol�way use her[Io <br /> /G /,�'> '1�y applied for and lurther ac�rees to remove same upon notice Irom Ihe <br /> Appmved lor Con ion Date City and to replace pubhc property damaged Ihereby. <br /> /-�-� ,/ <br /> FINAL INSPECTION � atc ��` <br /> Approved as Constmded SignaWre ol Applicant Da1c <br /> WORK AUTHORIZED BY THIS PEFiMIT MUST BE STARTED WITHIN <br /> evercu PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND T4EREAFTER IS TO ' <br /> � 3200CedarStmet BE OILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Evrrett,WA 98201 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona 259�8810 PROJECT OVER 90 DAYS DURATION. <br />