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� � <br /> 1"-,�1�'s$ � i- ��� <br /> o.�„��_,•,�...o�... � <br /> Date � <br /> [sioa oeo� .-� _....�����_ _ <br /> Anpl�catmn Por <br /> PUBLIC WORKS PERMIT °°°;o.«°ree 5 ---- - - <br /> �e�s�ooi feeve�a S - <br /> ea�e�..��e s �ncn <br /> Print or Type Only <br /> ���� �q �3 �'"I�AL�G( 14�� � ,� R� ] ��'l�a <br /> �'�I� �-�� Mading Atldre55 l. Gty Lp Phone <br /> � `��Ut.l�� P���S � �ly�u-1 ��rr��� i /-� ,�l u� n�� 98��l) l�� 3-�ia <br /> HF,p���a�� Madmg Address � Gty LD Phone <br /> Desr,ribe Proposed Work ���"�� �y� � � ��*--�� � ��-`_`-� � T� <br /> �r ,l W <br /> Pro;ect Addrnss U� Y.nowN '�C��� �? 1" '""�'� "" " (7" — � <br /> P.ttach lour(4)coPies oi Plans for proposed work� Draw lo scale anA note tl,e Io�ILwing as applicahle � <br /> • Pro�erfy I.mes • Cen�erline of sirer,t <br /> • Outhne and dimensions ol an ex�st�ng ana • Indlcate IJorth <br /> proposetl s�ru[tures on ihe l01 • Show any proPosed yiadmy changes <br /> • Ee�shny and proposed uh6fies • Show measuremenis � <br /> DO NOT WRITE BELOVJ 1HIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Decign and Conslruction <br /> S�andards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1-800•424'S555. � <br /> �G�� ^ .C-[ � CCI.yC�. :/)!�-.1L�.. /�`. �7 � C �� J A. . C/ �s'�/n"l_/ O <br /> '1i�tL. / fi �- /J��.�.. ..� � r�. c-r. � <br /> � � /� / 7 <br /> ��[" �-- ��C�G. !�-'�Ci, � <br /> ,� �;kt.r-C�,;.�. Seec'..� .SLe< <t.L• ., tl,.c� . / <br /> �/ �. i ti . ,-. ���a�i' ,. _ - _ ._ , `� -S-(c'>���i/' :�- <br /> �Z���c�i:ts.-C' -Q�',: � . � � � <br /> y T/t�. O <br /> a <br /> � �CKNOWLEDGEMENT OF CONDITIONS <br /> i he unders�gned ov.ner/app6cant h�reby agrees to holA and save ha�m� <br /> less the City ol Everett irom any and all clalms lor damages, cosis. <br /> expenses, or causes ol action that may anse because o� installa�ion <br /> '� ' //� � and maintenance ot the improvement or other rigM-obway use here�o <br /> ll��' �7c-�- 'L �=�9� ;,ppiied lor and furiher agrees to remove same upon nohce Irom ihe <br /> Approved for Consir tion Date City and to r place pubhc property da:naged iher?by. <br /> .� �� ///�f � � �� ���Q <br /> FINAL INSPECTION ���� Date <br /> qpproved as Constructed Sig ature ol Applicant <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> rverett PUBUCWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THF.REAFTER IS TO <br /> � 3200CedarSireet BE DILIGENiLY PURSUED TO COMPLETION. THIS P[RMIT IdAY BE <br /> Everett,WA98207 CANCELLED BV THE CITY UPOY ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAVS DURATION. <br />