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��� <br /> c� Q - <br /> ���%�c � <br /> � _� Date�� Pub�K Won�Anrmr . <br /> �-+ > � �� <br /> 1-3 Z H qppli�a�ion For Brap Oeo��+ <br /> ox� PUBLIC WORKS PERMIT �'°'�w°"'�°° -- <br /> ry� F„� � TMeifee S <br /> y ~ Lenf AOYI Poe Pu0 s <br /> �'l.� BaienceUoe $ ��%�// __ __ <br /> qy d Print or Type Only <br /> OM <br /> �"�g " <br /> ��hn�/lr. `�e�..<� /..?i�7 -:��e'a,v� E�-�c21 9fZan/ �_S�-�tz� ., <br /> 'Y Fi;�j OwnCt Mailing Atltlress City Zip Phone <br /> C � z <br /> gy y �C'n.,..s - — - <br /> � �� Applicant Mailing AtlCress Cily Z�p Pnonc <br /> ��� DeScribe Propo6ed Nbrk ��r�l/�" NVu 0011 ��f rSc,: �i1%�_-.___ ._ _ __ _ _ <br /> H O V� ` <br /> Pio�ecl AdtlreSs lil known) �O 3 � l -d � � <br /> l/ <br /> Allach lour 14)copies ol plans for proposeC work-Draw to scale and note Ihe lollowing as applicahir. � <br /> • Property Lines • Cenlerline o�sirect ♦^ <br /> • Outline and dimensions ol all exis;inq and • Indicate IJorth V� <br /> proposed siruclures on the bt • Show any pwposed yraAiny U�ange; <br /> • Eaisting and proposed ulilities • Show measurements Y <br /> ii% <br /> DO NO7 WRITE BELOW THIS LIN[ O <br /> ' PERMIT CONDITIONS <br /> (��� 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> i 2.All wo�k shall be pedormed in accordance with this permit and curcenl City ol Everett Des9n and Conslruction <br /> 1 Standards and Specilications. <br /> 1 ' 3.Call Location Underground Senice 4B hrs.belore you dig,TOLI FREE NUMDER 1•800•424•5555. � <br /> �� �� � . <br /> !' Oi , �� ( CC� li r�,i'. t�-. `�- c%�i r C /.% .� �'l�'; .�..� ��ji).-� �„�� ,jJj�: ,'��j <br /> i <br /> I _� ��Iw, <br /> �/ <br /> � -�=� a <br /> � _,� <br /> ' ACKNOWLEDGEI,AENT OF CONDITIONS <br /> � The untlersigned owner/applicant heieby agrees lo hold and,;rve harm� <br /> I� /. less ihe G�y ol [veret� Irom any and all claims far damaqes, co.=.L-., <br /> �_. eKpenses, or causes ol aclion ihat may arise bec2usr ol insiailotion <br /> ��� „� �� _ and malntenance oi the improvemenl or olher nght�ol-way usr hereto <br /> AnP�oved br Gonst aiion Date applied lor and lurlher agrees lo remove same uPon r,of�re irun, tna <br /> �� � Cily andio replace publi perty damaged ihereby. <br /> r <br /> � z _ �T � J . c. <br /> FINAL INSPECTION '�ule ' � f�' � - `1��� 9lr <br /> Approved as ConstructeA gnd�uro of Applicanl D�te <br /> rvrrrtt PUBLICWORKSDEPAPTMENi WOR�K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHItJ <br /> O 3200CedarStreet 180 DAYS OF OATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> Everetl.WA9�201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV �C <br /> Phona 259�BB10 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TI IIS <br /> PROJBCT OVER 30 DAYS DUf7ATION. <br />