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� <br /> I <br /> ��� __ _.. i <br /> - -- <br /> D� CyC DateL?�_� � vmi�cwo,�.r,. _„��_ <br /> �: y tiPPlicatron For eing D�o�a.��7`,y�3 u — <br /> M�� PUBLI� WORKS PERMIT °°°:oW�e�`°° 5 <br /> F� (� lessPoo�fncPaiEs <br /> H xl <br /> �H � Pri�N or Type Only �d�.,�:.��,�n s — <br /> WH <br /> � <br /> �� d r-1 �%'�'��-}- , f. �R'r'�'� I/�.�'�� `1`�pl 1(1f A\,� �'1 �"1� ���/ <br /> �y� �y Owner abny Atltlress Ciry Zip Phone <br /> 1-� O <br /> �"` " I I�/�l �/2 . ��/1Cl;N � " � �a <br /> H <br /> y y �Ap hcant MaJing Address Ctly Zip Phone <br /> t~ <br /> g� y T.�'I//�'��- 'T_h2t� ��2(�. CJ�. � <br /> M Descnbe Proposed Work <br /> �� y <br /> y� � W <br /> � ' Pro�ec�Atldress Id known) � � <br /> � Aitach lour(4)copies ol plan510r prOposed work�Oraw lo scale and nole ihe Inllowing as applicable: � <br /> • P�operty Lines • Centerline of sircet /^ <br /> • Outl�ne and dimensions o�all exishng and • Intlicate North V� <br /> pmposea slruclures on the lot • Show any proposed gratling changes <br /> • Ewsimg and proposetl util�ties • Show me05uremeMS � � <br /> I <br /> DO NOT WRITE BELOW THIS LINE � <br /> f 1 PERMITCOIJDITIONS O <br /> 1 ' 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> � 2.All work shall be pedormed m eccordance with this permit and wrrent City ol Everett Design and Conslruction <br /> '�' Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-600•�124•5555. � <br /> �`� �1�T i�jE6jv��2� � <br /> i-i �'� O <br /> �-� �-/-89 � <br /> -� � <br /> _� <br /> - O <br /> -� a <br /> � <br /> '-� �CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned uwneUapplicant here6y agrees to hold and save harm� <br /> ,�' less the Cily o� Everelt Irom any and all claims for damages, cosls. <br /> exnenses, or causes ol action that may arise because ol installation <br /> � �- �� and malntenance ol ihe improvernent or olher n�hPof�way use hereto <br /> applied lof and lurther agrees to �emOve 5ame UpOn notiCe irom the <br /> Approved lor Conslmction Date City and to replace pubhc property damaged thereUy. <br /> FINAI INSPECTION Oate <br /> Approved as ConsiruCied Sic�nature ot Applir,ant Dale <br /> evcrMt PUBLICWORRSDEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WI7HIN � <br /> O 32ooCedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS i0 <br /> EveretC WA98201 BE DILIG[NTLY PUFSUED TO COMPLC-TION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BV tHE CITV UPOIJ ANV STOPPAGE OF WORK ON THIS <br /> PFOJ[CT OV[R 90 DAYS DURATION. <br />