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_ ---. <br /> � �81B1..L11� o� � � Puoec wv��PaQrmn��� y,��7�'�,�,' . <br /> APPlitalioo Fo� BIdY D�Dt� --Y—i-.!lJS�-+� <br /> - <br /> PUBLIC WORKS PERMIT vuOTotelFee`es ,- - <br /> Lu�Aov�Fe�Pu0 S <br /> � Print or Type Only B�I�nc�Due s <br /> � � � � .03 ' <br /> f <br /> Owner Ma �np Address Cily Zip Phone � <br /> � V, <br /> Applicant Mellinp Atldresa City Lip Phone �. <br /> Dewribe Propoeed Work �I�L�!�-� - � �-��v.� ' <br /> � <br /> . i <br /> � <br /> . W � <br /> Pro��ct Addrees 111 knownl � I <br /> I <br /> Att�ch four(4)eopies of plans lor proposed work• Drew to aeale end note the lollowing ae applfcable: � ' <br /> • Proparly Unas • Centerline ol etreet � j <br /> • Outline and tllmenaions ol all exiatinp and • Indicale North � <br /> propoeeG slructuree on ihe lol • Show any propoaed qratlfng chanpea <br /> • EMlellnp and proposed utlllUea • Show measuramenta � � <br /> 1 <br /> L HI L O i <br /> PEFMIT CONDITIONS <br /> 1.IUI calb for intpsctlon�h�ll be mede 24 hre.In advance-phone 260-8a1 O. � <br /> 2.All work�hall bs peAonned In accordance wlih thls pe�mit and cunent Clly of Everett Dealpn end Conetructlon ' ; <br /> Shnduds�nd 3pecllladons ; <br /> 3.Call Lxa6on Underqround Senlce 4B hra.belore you dip.TOLL f11EE NUM�E111�800�42456bb. � '; <br /> r�-r �g - O <br /> a���� �, <br /> /o-iZ-99 ' <br /> � : <br /> O { <br /> � <br /> a � <br /> � <br /> � <br /> ACKNOWLFOGEMENT OF CONDITIONS <br /> The undersigned uwner/applicant hereby ag�ees lo hold and save herm• � <br /> Inss the Cily ol Eve�elt Irom any end all cleima lor damages, cosla � <br /> e�penses, or cauaes ol ection Ihat may arise beceuae of Inalalletlon � <br /> and mainlenance of the improvement or olher riphl•oi•way use herelo � <br /> applied lor end lurther ag�ees lo remove aeme upon notice Irom the <br /> ADDroved lor Construction Dato Clly end to replace public property damaBed ihereby. ' <br /> � FINALINSPEC�ION Date <br /> i ADproved as Conatructed Signature ol Applicant Dale <br /> � WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> � everett PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street <br /> i � BE DILIGENTLV PURSUED TO COMPIET�ON. THIS PERMIT MAY BE <br /> � Everet6 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � Phone:259•8810 pROJECT OVER 90 DAVS DURATION. <br />