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0����5-1`���I , . :. .. .. . '"7 <br /> APPliral�on For �� �i n.... �,..��� �C.�� l� <br /> PUBLtC WORKS PERMIT � � w�,���,.� <br /> � ,,�.,,�.� �----- <br /> �,...<:,�„ �.,.�A.� s— — — — <br /> Print or Type Only ����������•n,,,. s _ <br /> ��� (,�?�a�X� �1 I I � CA.►r� � � �P��3 ���`'T <br /> O ne� Mailing.ltltlress �1 Iip Pho�e �� <br /> __—_.._--_ _ <br /> ApP�.^ent 1Aaihng Atltlress CitY Zip Phonr --� --.—.... <br /> Describc ProposeJ Woik _���,L�1S,��— _ ___ <br /> Pro�ecl AtlAiess UI know�nl —��!—1�L'lii_L.1-1—.�_Q.7L— � <br /> Altach fow I�I copies o�� plans lor propos�?C work � D�aw lo scale and note Ine lollowing as apPlicahlu� � <br /> • Properly Lines • Centedine ot street � <br /> • Oa1Lne and dimensions o�all r..ish•,�anA • Indiwle North <br /> proposetl Slructwes on th� ot • Show any proposetl g�,dmy r.hanges <br /> • E.istinq and proposed ul �ities • Show meaturements � <br /> ����RITE BELOW ThIIS LINE O <br /> PERh11T CONDITIONS <br /> 1.All cells lor inspect�on shall be made 24 hrs.in advanca- phune i 53•881 O. � <br /> 2.All work�hall be perlormed in accnrdance witL�his permil ned current City ol Everett Design and Consiruction <br /> Standards and Specificahons. <br /> 3.Call Loca�ion Underground Serviar 46 hrs. bniore you dig.TOLL F7EE NUMBER 7•800•424-$55rJ. � <br /> _ / /� � � � O <br /> �'��[ i �L.�i�.•� .- /'%� �i. , / /l i� /�l�C ` c 1 � �/ .�/.i / �;�_ ,/.� � <br /> -ff/ YJc'. <br /> � ( � �� f <br /> rY/!• ��`-' } � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownei/applicant hereUy ayrecs to holtl and save harm• <br /> --- less Ihe Gly �I Crercl� Irnm any and all cla�mn !or tlameBes. costs, <br /> e�penses, or causes ol nclion Ihat may ansn Lecnuce nl inslallation <br /> and mainlenance nl Ihe improvemrnt or other nght�ol�way use hereto <br /> applieA for and Iwther agrees lo removc Seme upon notice from Ihe <br /> Approved lor Construc6on Date Clty and to inplace public property damaged ihereby. <br /> FINAL INSCECTION Date <br /> Approved as Const�ucted S�gnalure ol Applicant Dale <br /> evPrrtl PUBLIC WORNSDEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUSi BE STARTED l4iTt!�N <br /> � 320�CedarStree� 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFiER IS TO <br /> Everett.WA 99PC1 BE DIUGENTLV PURSUED 10 COMPLETION. THIS PERMIT MAY BE <br /> P�one�.259�8010 CANCELLED BV TNE CITY UPON ANV STOPPAGE OF WOFK ON THIS <br /> PROJ[CT OVER 90 DAVS DURATION. <br />