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i <br /> I <br /> DAte[�L9Lf� r` � I v��ni��.wo,w.r�, i��?�����, <br /> APUlitali�n Fa I ����v ovoi • �.�QYJ[dL.K/_ --. '. <br /> PUBLIC WORKS PERMIT ' ^°°°°-W°,�°��°-- -- _ <br /> ,a�.��.� s_. <br /> leaa ennl Ie.rn�o S <br /> Print or Type Only 8�����a��� s —_ <br /> �'�I�`P��'� ��L?��lY�l.vN� t� �l�'_l?lY1LY'2� ', , �j�yj�{:( � <br /> Owner Maihng AAdress C ly 2 p Phone /�r��ll <br /> AppGcent Maihng AddrosS Gty Zip Phone - <br /> Deacribe Proposed Work ��-� �v� ��/ �l/ — �. <br /> � W '� <br /> Projact Address�il knownl . � � <br /> �' Attach low(4) copios of plena br proposed work- Draw to scale nnd nole Ihe lollowing as applicable: � <br /> • Prope�tY Lines • Centerhne ol street � <br /> �� • Ovtline and dimenaions oi an existing and • Indicate Norih <br /> pioposed slrucWres on ihe lol • Show eny proposed grnding chenges <br /> • ExI5U�4 and proposed ullhlies • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> . PERMIT CONDITIONS <br /> � 1.All cells lor inupectlon shall be made 24 hrs.In advance-{.hone 259�8610. � <br /> 2.All work shell be peAormed in eccordanca wlth this pernilt and currenl City ol Everett Design and Construction <br /> Stenderde end Specificellons. <br /> � 3.Cetl Lxelion Underground Service 4H hrs.beforo you dig.TOLL FREE NUMBEN 1•800•424•5555. � <br /> � � O <br /> r <br /> � , ,, �c�-l> � <br /> � /¢ -��� N <br /> O � <br /> a � <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> The undersigned ownei/appLcanl herehy agrees to hold and snve harm� <br /> -- less the Cily ol Everett Iron any and all claims for damapes, cusls. <br /> e�penses. or causes o� action Ihat may aiise because ol inslallation <br /> and maintrnnnce ol Ihe imprnvemenl or other nghDol�wey use herelo <br /> _ applied for and lurther agreer to remove seme upon nolicn I�om Ihe <br /> Approved Im Construction �a�P City and to replace pubhc propnrty dameged ihereby. ��. <br /> FINAL INSF'ECTION Date <br /> App�oved as Constructed SiynaWre ol Applicanl Date <br /> everett PUIILIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN � <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200Ceder5lreet BE DILIGENTLY PURSUED TO COMPLETION. T111S PENMIT MAV BE <br /> Evere�L WA 98201 CANCELLED BY THE CITY UPON ANY STOPf'AGE OF WOFK ON THIS <br /> Phone�.259�8810 PROJECT OVER 90 DAVS DURATION. <br /> I <br /> I <br /> i <br />