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Date��___� � I <br />� <br />Auplicatiar Fnr <br />PUBLIC WORK� PERMIT <br />Print or Type O�ly <br />Applicnnt <br />iL��ii_�`� �_' �. <br />Matlmp AAAresc <br />MxJ��ig AAd�es:, _—__ _ . __ <br />� <br />� „�.�„ w., .. �,., m � . � <br />�� � �� a�7 <br />f+inn w.�� . __'�_ ' _ _f____'�- <br />_-- - ---- --- -- _ <br />�,,,,�� W,,,,,,,,. <br />,.,,,�.�� s__—__— <br />�.,..�,�,: �.. oa„ s — . <br />�,., .,� a �,,,. s -- . <br />� � � �_�; � �'` i,�l ; J%V(� <br />7�P Phone <br />G�y Lp <br />Deacribe Proposed Work 1��- �_L�� � I( S <br />Pro�ect Addresa �il kno..n, <br />Allech lour (4) copies ol plans lor proposod work � Drew to scxle and note Ihe lollowing <br />• Prcperly Llnes <br />• Out6ne and dimenswns ol ell erisimp and <br />proposetl siruclures on the lol <br />• E�isUng and proposed utiGties <br />• Cenlerlme ol sheM <br />• Inditate Narth <br />• Show any propo5ed yrnNng chnnges <br />• Show measuremen�s <br />PERMIT CONDITIONS <br />7. All calln fo� Inepection shell be made 24 hie. In edvance - phone 259•8810. <br />2. All work ehell6e performed In accordance with ihis permit and current City ol Everett Design end Consiruction <br />Stendarde and Specilications. <br />3. Call Location Undarg�ound Servicn 48 hra. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� l�,j- .��-�, <br />Apprnved lor Consiruclion Dn�e <br />--�/ � /� � <br />� �^ , '/� %?j�+„�j'i <br />// // �'1 ,� % <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />O <br />a <br />The u��Acrs:c�ned owner/applicunt heroby agn!r�e to hold end 6ave harm� <br />Ir,ss �he City ol Everett Irom any end nll claims lor Jamnges. coets. <br />c�penses. or causes of aclion that may a�ise because of Inslallation <br />and mamtenante ol lhe improvemen� or other nght�obway use hereto <br />ann'�A� �or and lurthe� aqrees to remove same uoon notice hom �he <br />CiIY ���d to replac� P,�bhc property damaged �herebY. <br />1 INAL INSPECTION Dnle _ _ <br />, Approved as Conatructed Siynaturn nl Applicant Dale <br />� everett PUBLICWORKSDEPARiMFNT WCRK AUTiiORIZF.D 8Y THIS PENMIT MUST BE STAFTED WITHIN <br />� 3200CedarS�rea� iB0 DAVS OF UATE PEFMIT IS ISSUED AND THEREAFTEF IS TO <br />Everett, WA 99201 BE DILIGENTLV PURSUED TO COMPLETION. iHIS PERMIT MAY BE <br />Phone: 259�BB10 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WqRK ON THIS <br />Pi70JECT OVER 90 DAVS UUtiATION <br />