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�.�'. <br /> , <br /> ♦.nT4Y <br /> 1 � <br /> � <br /> ���� �8te /d y PUELc WorAt iarml�• „�y <br /> �a y� Appllcatl�For � Bm°o.oi .� a 7�PG <br /> �� PUgLIC WORKS PERMIT °°°.o,;;::"• � <br /> ��O L�u�n0�Fu PUE S <br /> Itl <br /> � � B���nu0u� S <br /> �= Print or Type Only <br /> L�i pq ,r1+x-c.�...��� C.o �� !I 7?� � i,� o,� _ 76 � _-PLa�� �F/z f� 3Y.�—s'T7d' <br /> ` �.�. <br /> p� Owner MeiUng Atldrese City Zip Phone <br /> �i y� �L v-rci-✓ <br /> N APPiicant Mailing Address Clly 21P P�ane <br /> � <br /> g�� � . ��, ��� <br /> � � DeeCrlbe Proposed Work T I 2�r�u <br /> O tN <br />, � <br /> Prolect ACdreea(lf known) 3�e 3 L✓ �"-""`• �`� ' '�"��`e v�— r v ~ <br /> f � Attach lour(4)coples ol plana lor propased work-Draw lo scale and note the lollowing as applicable: � <br /> p • PrOparty Lines • Cenlerline of street � <br /> i � • Oulline end dimen6�on6 0l ell existlnp and • InCicate North / <br />� propoaed etructures on lhe lol • Show any proposed prading chen0es <br /> • EaleUng end proposed utllitiea • Show measurementa � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> ,^?':� 1.All celle lor inepectlon shall 6e maEe 24 hrs.in edvence•phone 259•8810. � <br /> + 2.All work ehell be parformed In accordanCe wilh t�le permlt and current City ol Everett Deslgn antl Conatruction � <br /> StandarEe and Specillcatlona <br /> i � 3.Call Lxatlon Underground Service 48 hra bclore you dip.TOLL FpEE NUMBER 1•800�424•5555. � <br /> i <br /> C� �C tt��<c Cv(��✓�: t�C.,.,.,�f .";.f ;� .. �j � <br /> i � <br /> �� `1�i � <br /> . o <br /> ' __ a <br /> �i `1� . ACKNOWIEDGEMENT OF CONO�TIONS <br /> t The undersigned owner/aOPlicant heraby agrees lo holtl and save herm� <br /> , less the Cily of Everelt lrom eny and all claims lor damages, cosls <br /> expenses, or causes ol action thal may arise beceuse ol inslallatior <br /> � end maintenance ol Ihe improvemenl or other right�ot�way use herelo <br /> applied lor and luriher agrees to remove semo upon notice imm Ihe <br /> Approved lor Conatruction Dale City and lo replace puhlic pmperry damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature ol Applicant Oale <br /> PUBLIC WORKSDEPARTMENT H'�RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �200CederSlreet 180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> `,�- ' Everel4 WA9B201 BE DILIGENTLY PUFSUED TO Cl)MPLETION.THIS PERMIT MAY BE <br /> ` .i r r�'� Phone:259�BB10 CANCEILED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> :�.:+�.i:.:n�:.�', . pROJECT OVER 90 DAYS DURATION. <br />