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�, _�z <br /> p8�@��� Pu�bc Worxe Permn• �-� <br /> AppliCahon For map oem • _ <br /> PUBLIC WORKS PERMIT °„°��°W°,�,�°° : — <br /> .o�.���. <br /> �e..eor� �e�vna S <br /> Print or Type Only Ba����so�� 8�nU <br /> 1 �P I(17����4� )1'1►'�1 �1�P g � 1/L- <br /> ��wne Melhng Adtlress �ty Lp Phone <br /> — ][.l-Y V N . <br /> Applcent MaifinyAddress City Lp Phone <br /> DescNbe Proposed Work ���.• �` �!� <br /> Prolacl Adtlreae lil knownl � �� � � <br /> � <br /> Atlech lour(4)copies ol plana lor praDeged work� Draw to scale and note ihe lollowinp es applicnble�. � <br /> • Properry Linea � Centeiline ol streel � <br /> • Outline and dimeneions ol ell ezisting and • Indir,ate Nor�h <br /> pfoposed 6trUCturBe on ihe tot • Show Bny proposed grading thang�s <br /> • E■leting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor Inepection ehall be made 24 hra.In edvence•phone 259•8810. � <br /> 2.All wo�k ehell be perlormed in accordence with thia permit and current City ol Eve�elt Design end Conatructlon <br /> Stendarda end Speclllcationa. <br /> 3.Call Lxatlon Underground Service 48 hrs.belore you diB.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ?he undersignatl owner/npplicant hereby ag�ees te holJ antl save harm- <br /> less the City of Everet� Irom any and all claims lor tlamngas, costs, <br /> ezpenses, or causes of action that may arise becauso ol installation <br /> <�����,� �.�, Q �p and mamlenance ol ihc improvement or other right�ol�way use herelo <br /> �� / .. O <br /> npplled lor and furihcr agrees to remove same upon nolice i�om Ihe <br /> Approved lor Conslr on Date Clty and lo replace pubhc properry damaged Ihereby. <br /> � /J-/- iF <br /> FINAL IN EC :JN Date <br /> ppproved aa CcnsVucted Signature ol Apphcant Dale <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZ[D BV THIS PERMIT MUST BE SiARTED WITHIN <br /> � 3200CederStreel 1B0 DAVS OF DATE PERMIT IS ISSUED AND iHEREAFTER IS TO <br /> Everelt.WA9B201 BE DIIIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�BB70 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS UURATION. <br />