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08t9�� vuexe wen�P.rinn• " � �•• <br /> Blap.D�ol.• <br /> ApplicaHon For <br /> PUBLIC WORKS PERMIT �be�FNF�� • e• Z <br /> L�u�Ool i��Pu0 S j <br /> a.�.�.o�. s 76E•�T� <br /> Print or Type Only 7o?�fl�r., <br /> �2J J .5�07 �//� " d� C�C /� a7J// �/F��- .�J:3 <br /> er Mallfnp Addresn CitY 2ip Phone <br /> f <br /> i <br /> i , ��-- �rD' �lPtifh�,zp� �nMe__ Pno�O � <br /> � �pP���s��� Mslllnp Address Cfly 21p <br /> Dascrlbe Praposed Wark v �� �� �"'"� I <br /> W <br /> Pro�ect Addrese 111 known) � <br /> Attaeh four(4)copies ol pl�na lor propoeed work•Drew to acale and note thx lollowing ea apP��cable: � <br /> � P�o�����e6 • Centerllne of street � <br /> •Outllne�nd dimenelons of ell eMiatinp end • Indicate NOAh <br /> proposed etructuree on the lot • Show eny proposetl predinp chanpes <br /> • Existinp�nd proposed utilitlee • Show measuremente M <br /> W <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1. All C�IIs IOr InspeCtlOn ehall be mede 24 hra in edvenCe•phonB 259•887 b. � <br /> � 2. All work shell be peAormed In accordance with thle permit end current City ot Everett Deeip�and Conetructlon <br /> 3tenderds�nd Specillcatlona � <br /> 3. Cali Locatlon Underpround Service 4B hre.befure you diq.TOLL FREE NUMBER 1•800�424•5565. <br /> 4 �-h- �T����-.s O <br /> _ � <br /> cl� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The untlersigned owner/applicent hereby agraee to hold and aave harm• <br /> less Ihe Cily ol Everett iram any and all claima tor damepe& cosls, <br /> eepenaes, or tauses ol attlon thel mey eriee bacause ol inatallallon <br /> � �!1 and mainlanen ol ihe improvement or other right•ol•way use hereto <br /> �,,�����/a • ^ �Z_� `� � applled lor a her agrees to remove aame upon notice irom the <br /> Approve or onetruction Date City end t ublic propert qed thereby. <br /> �-%�� r• sz. er <br /> INAL INSPECTION Date Dele <br /> ADProved ae Conslructed Signature pp icen <br /> WORK AUTHORI2ED BY THIS PERMIT MUST E STARTED WITHIN <br /> everctt PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedet Streel BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Evere�i,WA 98201 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIIIS <br /> Phone: 259•0815 PROJECT OVER 50 OAVS�URATION. <br />