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- _ "�� <br /> Dl7'�C ///�}��// PuhI,C\YOrMiPPIT����ryf � I <br /> �[ . —� 61dB OePt� '__i���l ._ <br /> Applir,a��cn For I <br /> PUBLIC WORKS PERNIIT ��°°��°W°^°'°° ---- i <br /> To���F�e s_--- <br /> �esa ann� «e Pn�a S <br /> oaiance�ue S <br /> Print or Type Only � <br /> „�V�/1)T7� NI[=}{+� �A-.i.�w�� IV./Y�X..J7fU41 �/pJY)� �l1t_!M Q'1��f-_J7..2-�-- �I <br /> �N,�e� Mading Htltlress Cdy 2iP Phone <br /> .�a�,�,2 -- <br /> qppl�canl Mad�ng Address City LP Phone <br /> Describe ProposeC Work �el�l1 }�"���'^ �—l� �`� �a��-�J`�����+���—�'�"'��'� <br /> Project Address UI known) �aa cpld�.�_� � I <br /> � <br /> Attach lour f<I copies ol plans lor proposed woik- Dravi to scalc and note the lollowing as apPlicable�. � <br /> • ProPPrty Lines • Centerline of slreet � <br /> • Outhne and dimensions ot a0 exisfing and • Indicale North <br /> prcpased strucidres on Ihe lot • Show any proposeA 9rading changes <br /> • Eaisling and proposed u�i6lie5 • Show measuremen's M <br /> W <br /> DO NOT WRITE OELOW THIS LINE O I <br /> PERMITCONDITIONS <br /> 1.All calls lur inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit end wrrenl Cily of Everett Design and Censtruction <br /> Standartls and Specifications. <br /> 3.Call Localion Underground Service 48 hrs.before you d:g.TOIL FREE NUMBER 1•800•424•5555. � <br /> �_��%,P..��-�.� ���,��" � <br /> / �'�� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm� <br /> less ihe Cdy ot Everett from any a�d all claims for damages, cosis. <br /> expenses. or causes of aclion that may arise because of installat�on <br /> and maintenance ol ihe improvemeni or othei ngh4obw:�y use hereto <br /> applied br and furiher agrees to remove same upon nctice t�om the <br /> Approved lo�ConsvucLon ���� City and to replace pubhc property damaged Ihereby. <br /> F�NAL INSPECTION �ate Date <br /> Approved as Constructed SignaWre at Applicant <br /> WORK AUTHORI2ED BY THIS PERMIT A1UBT BE STARTED WITH��N <br /> evereu PUBLICWORKSDEPARTMENi 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DILIGENTIY PURSUEOICCOMPLETION. THIS PERMIT MAV �E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />