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Date � ^ .._. �,,,im�wa,.,n.,,,,�pi p -/�-?— <br /> n�n�i o«o� . __0 J��o���TJ <br /> Applicatio.. For <br /> PUBLIC WORKS PERMIT ''��^���w°�.���° - - - - <br /> ,�,���.. a_ <br /> �.,_.�„ �..�•a,, s_ —_ <br /> �.�. .�,,, a <br /> Print or Type nnly --- <br /> Ge���t �1 l�til,�� lll0 C„lEnn�e 1�r t=✓a.nt� 4� za� .�s �z—�si�- <br /> pW�P� Madmg�tldress Cny 2ip Phone <br /> SaM �' — -- — — <br /> Apphcant Mading Addrrss Crty Zip Phone <br /> Descnbe Proposed Work �f)'/7 ���d✓� � C�L.e�a2�ls� rPri�f�i Q _ <br /> /� /� W <br /> P�olect Address Iil knownl I�l��.QS�T � <br /> Altach lou�141 copies ol Plens lor proposed work � Draw Io sr.ale and note the lollowu a as apPlicable�. � <br /> • Propeity Linea • Gemerlme ol slreet � <br /> • Outline xnd dimensions of all exisling anA • Intlicate North <br /> proposetl s�ruclures on ihe lot • Show any proposed gratling changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WAITE RFI flW THIS LINE O <br /> PERMII CONDITIONS <br /> 1.All calls lor Inspectlon shell be made 24 hrs.in advance-phonr 259•8810. � <br /> 2.All wmk ahell be pedormed In acco�dence with this permit end wrrent City ol Everett Design and Consirucflon <br /> Slenderde end Specllications. <br /> 3.Cell Locetion Undergrountl Service 4B hrs.betore you dig.70LL FFEE NUMBER 1•800•424•5555. � <br /> O <br /> ��� ��� ���� � <br /> v-�� �q � <br /> O <br /> a <br /> �CNNOWLEDG[MENi OF CONDITIONS <br /> Thc undersigneA owner/apphcent hereby a.grees to hold and save harm• <br /> �-- Icss Ihe Cdy ol Everetl Irom nny and all c,lpims lor damages, costs. <br /> e.penses. or causes of xction that may anse beceuse ol inslallation <br /> and mamtennnce of Ihe improvement oi o�her righbol�way use here�:. <br /> apphetl loi and lurlher agrees lo remnve seme upon nohce hum ihe <br /> Approved lor ConsLuction Date Gl�y anA �o replace pubhc prope��y dAn�.tged�her¢6y. <br /> FINAL INSi'ECTION D��e <br /> Approved as Constructed Siynaluie ol Apphcan� Oale <br /> WORK AUiHORIZEU BY TNIS F'EFMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAVS OF DATE PERMIT IS ISSUED AND THEREHFTFR IS TO <br /> � 9200 Cedar Slrael BE DIUGENTLY PUFSUED TO COMPLETION. 1HIS PEFMI i NAV BE <br /> Everall,WA 99201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone�.259�B810 PROJECT OVER 90 DAVS DURATION. <br />