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Date��d �,m���w��w,r�,mn. ? �� _ <br /> Applicetion For Bmp oen� •��.�ri�_ <br /> PUBLIC WORKS PERMIT Pu�i¢WorM�fee <br /> Tol�i Fee �— <br /> lese�p0� �en P�id 5 <br /> BebncaUuo � <br /> Print or Type Only <br /> (� „�,.. a ���0��1 ��S F �zYLRr� .su��n C �vn�NN 9��zp� <br /> pwneT Mailinp AtlOress Ciry 2ip Phone <br /> S6� ' ) Sp��R � 1M6 Pn�,v"-�S� �:�'� l� �cHcl Gt/i4 � E�3-a99� <br /> Apphcs�r t Mading Atltlrees Cdy � hone <br /> DeecribeP�oposedWork �rAA 'I- itiYlD2v,l�u. � <br /> a <br /> W <br /> Pro1ee1 AtlOrese 111 knownl � �` • CQ S� � <br /> AtteCh lour(4)coplae ol Dlene lor proposed N•ork� Drew to scxle and nola Ihe lollowing es appGcable: � <br /> • Property Linee • Centerline ol street � � <br /> • Outline and dimanelons of all eRisting end • Indicete Norlh <br /> p�opOeed BI�ucWres on iha lo� • Show any proposed gretling thanges <br /> • Exiatinp end propoaed ulllities • Show measuremenis � <br /> DO NOi WRITE BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> t.All celle lor Ineper,tlon shell ba mede 24 hrs.In edvence•phone ZS9•BB�O. �� <br /> 2.All work ahell be peAormeO In eccordance with thla permit end current City ot Everett DxsiBn end Conatruction <br /> Stenderda and Specilicetlona. <br /> 3.Cell Laatlon Underground Service 4B hre.before you AIO.TOIL FREE NUMBER 1•800•424•5555. � <br /> �1/oT,P�r� , 4 <br /> ��,�•� 3 i�88 � <br /> � <br /> 0 <br /> a <br /> ACKNGWLEDG[MEN7 OF CONDITIONS <br /> The untlersignetl owner/applicnnt hereby agrees to hold and snve herm- <br /> - Icss ihe City ol Everett Irom any end ell cleims lor demages, costs, <br /> e�penses, or ceuses of action ihal may arise baceusa of instelletion <br /> end maintenance oi the improvement or other righl�al�wey use hereto <br /> - epplied for end Iwther agrees to remove same upon notice Irom Ihe <br /> Approvetl lor Construction Dete Ci�y end lo replace pubGc property demaped Ihereby. <br /> FINAL INSPECTtON Oate _ <br /> App�ovad ae Conelructed Signeture ol AppGcant Date <br /> evemtl PUBIICWORKSDEPAFTMENT WORK AUTNORI2ED BY THIS PEFMIT MUST BE S7ARTED WITHIN <br /> � 3�OOCader9lraet 180 DAVS OF DATE PEHMIT IS ISSUED AND THERF.AFTER IS TO <br /> Evarett.WA9B201 BE DILIGENTLY PIIRSUED TO COMPLETION. THIS P[RMIT MAV BE <br /> Phone.259�BB10 CANCELLED BV Ti�E CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PFOJECT OVER 90 DAVS DURATION. <br />