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oete�LL� 8� �.{_/�����1y�— <br /> i�m,�.�:w�,,.s i•n,�, . <br /> Application For x�nu n�n� � —��S711J__LJ_ <br /> PUBLIC WORKS PERMIT �u1io�IFeeF�I : <br /> vu�ooi ree Fna s _ <br /> Prinl or Type Only n,����.o,�� s <br /> �, te� T�[�SVY1��� <br /> ner Mniling Address Gty Zip Phone <br /> Applicxnt Meiling Address C�ly Zip Phone <br /> Deecribe Proposed 6York ������— • — _ <br /> ' �.5�q ('„ Ir �vnia ,/�JQ W <br /> Prolect Address lif knownl � <br /> Attech lour(4)copies of plans lor proposed work- Draw to scale ond note Qie following as applicnMe. � <br /> • Property Lines • Cenlerline of street � <br /> • Outline BnA dimensions ol BII existing nnC • �ndicale North <br /> propcsed slruclwes on the lot • Show any oroposed�7radin�chan9es <br /> • Exisling end proposed utili�ies • Show mensmements � <br /> DO NOT WRITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS <br /> 1.All cells lor Inapactlon ahell be mede 24 hrs.in edvance-phone 259•8810. � <br /> 2.All work shell be padormed In ecwrdence with ihis permil and current City ol Everett Dr.slgn and Consiruclion <br /> Stenderda end Specllicallons. <br /> 3.Call Locetion Underpround Service 48 h�s.belore you die�.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> � <br /> � <br /> �1�� l°,��,ti�:f ,��� ,� � u�,/ 9- �h-, �s O <br /> � ��`" > -� a <br /> ,� � <br /> ACKNOWLCD;[MENT OF CONDITIONS <br /> Th�undr�rs�9ned ownrVapPlir.ant herehy agrees to hold anA s�ve harm- <br /> Inss the Gty of Everelt Irom any and all claims lor d2mxgas, costs. <br /> espenses. or causes ol nU�on ihal may anse because ol inslallalion <br /> and namtenanc�• ol Ihe unprovemem o� olher nghbol�way use he�elo <br /> -- pppheA lor an� lurihci ayr��s to remove same upon notice Irom �he <br /> Approved lo�ConsVuclion Date Cdy anA lo replace putilic propenY dama9ed thrieby <br /> FINAL INSPEf.TION Date --- <br /> Approvetl 05 Cons�rucled Si9nat.ue nl Ap{N�r.ant Date <br /> everell PUBLICWORKSDEPARTMENT WORK AUiHORIZGD BV THIS P[RMIT MUS7 EL STAFTED WITHIN <br /> � 9200CederSlrret 180 DAVS OF DATF PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> Everetl,WA99201 �6 DILIG[NiIY PURSUED TO COMPLETION. THIS PERM.R MAV BC <br /> Pbona 259�d810 CANC[LLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECI OV[R 90 DAVS DU:7ATION <br />