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�8�en �,�- /L[ Pu�l¢Wor��Permn• `�'��3 <br /> �flYl p �� <br /> ( - BIUO Oept �__ <br /> Appllcetion For <br /> PUBLIC WORKS PEP�MIT "°°"""°'".". <br /> TOW Fes � <br /> Leu�pDl.ie�PUE { <br /> B�I�nce Oun � �� <br /> Print or Type Only <br /> -� <br /> wner Meiling Address City ZIp Phone <br /> Applicant Mailing Addreas Cily Zlp Phone <br /> Descrlbe Proposed Wo�k P �/ ,1'iAo�P fn_d1lltLtilL�*±� - <br /> J <br /> W <br /> Pio�ecl Addreae(if known) — C ~ � <br /> Atlech lour(4)coplee o�plene lor propoaed work- Drew to ecale and nota ihe lollowing as applicable: � � <br /> • Centerline ol slreet � <br /> • Property llnee � <br /> Imen9ions ol all ezisllnB and � Indicate <br /> Norih � <br /> •Oulline end d I <br /> proposed etmcturea on the bt • Show eny proposed gradln0 chenges � <br /> • Existlnp end p�oposed ullllliea • Show measurementa � <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1, All cel�s lor inepoctlon ahell be mede 24 hra.In edvance-phone 259•881 5. � <br /> 2. All work ehall be peAormetl in ercordenco with thla permit end currenl City ol Everett Design and Conatiuction <br /> Standarde and Specllicallons <br /> 3. Call Locallon Underground Servica 4d hrs. 6efore you dip.TOLL FHEE NUMBER 1•800•424•5555. � <br /> 7`. I�lS7ALf /2��C'o.dCeE7F CULliE2T LlAJO� O <br /> l�.eivEc.�Af//�1/Dircy •9T .Pars�o�dF'y � <br /> � <br /> O <br /> a <br /> �( ACKNOWLEDGEMF.NT OF CONDITIONS <br /> _d/�17' The unde�signed owner/npPlicanl hereby agreea to hold and seve harm� <br /> �T ' less the City ol Everetl Irom eny and ell clelms lor tlemeges. costs. <br /> expenses, or ceuses oi ncti�n ihnl mey erisa beceuse ol installetion <br /> � �r�i p,29 86 and meinlenance ol the improvemeN or other ngld•of-wey use hereto <br /> Pi v �J ' epplied tor end ludher egrees to remove seme upon notice hom Ihe <br /> Approved for Co strudion e�B City and to�eplaca public property damaged thereby. <br /> �/�y� � �r��c%� t,�-���Y�9-�l0 <br /> AL NSPEC ION Date ' <br /> Approved as Consiructed Signulure ol Applicant <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> eve�en 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireot BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED DV TNE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8815 pROJECT OVER 90 DAYS DURATION. <br />