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^ <br />oat•ld d�/ <br />AppYF Ian FOR <br />BLN O.F. <br />&WORK. <br />PUBLIC WORKS PERMIT <br />is rind IS <br />Print or Type Only <br />• <br />og!e D l! p &, e f /in <br />E✓pAn/f <br />9,FWG <br />dse-f3w <br />tea <br />q ne, MaIMp .. <br />Cloy <br />Zip <br />FnpnB <br />SO nT <br />AIMIIC.nI MHILnv Apa,ry <br />CITY <br />zip <br />PoOnB <br />Deunce Promsed Work TNCUI ,`Mqnvao <br />ra-AP..'.& <br />S_L _ <br />W <br />ProNPl Address pl anowm <br />Aaact, lour wl Cables W pans Imp,. Wwork-Draw to scale and mole the following and applicable. <br />• Properly Laos • Comarline of street <br />'A <br />• Outline and dimensions son all arming and •Isabelle Nnnn <br />v, <br />prompted structures on the rot • Snow any Proposed gredg Changes <br />• E.rsnng and propwem uhfibes • Show measurements <br />y <br />EWl E <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMITCONDITIONS <br />1. NI elpa fG,moder made ade in thisrom phone2$&8810 <br />y pedma In <br />z. Rath penommaasaormnel with lnM Permhaw current uW of Ererstl Gaign area eoalmcvpn <br />SAd t" Bpacti <br />s <br />LWsarea nann <br />1CNLWBm UrWI¢Una SelybHlrT lMlga yW dry TOLL FREE NUMBER I'ROD4P4$$$$. <br />O <br />M-26'B9 <br />0 <br />a <br />Apq for Conebucnon Date <br />FINAL INSPECTION Date <br />App "and Constructed <br />PoB KSO <br />EPAMEM <br />S1pCanada <br />EreItWA101OWbe154"10 <br />The undersigned ownerla pplicant hereby sore&$ to dole and ss.e harm <br />Mee the City of Everett from any and all mime for damagescosta <br />assand maintenance <br />pr ncuHa Of action that MAY area because of Instalment <br />and and for and m er igrees I mem or ewer nvhhopn notice efr .rem <br />City an lm and lenwere Prop to re oboe from me <br />City ewe m t.pLa wain prownr aamava ma upon <br />n <br />nlanalure of APPIIUM Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />