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! <br /> .�... . <br /> ��� �� ,� PuO��c Wo�he Po�mil� <br /> Date—LL-L'��� , —• �?(� • � <br /> ninq orm • —��— <br /> Application For <br /> PUBLIC WORKS PERMIT °°°"`"'°"„°° - <br /> .����F�a S <br /> �essnoo�.FeoPao S <br /> f�ai.�ncu000 5_ <br /> Print or Type Only <br /> q�� ( �I� � �,� Mailin9.4Adress City Z�p Phone <br /> � y y Owner <br /> H �H — --- Phone <br /> K' � � qpplicant Mailiny Address Cdy Z�P <br /> � V1H �� � �' I �lf� 1 � �� _— <br /> Describe Proposed Wo�k <br /> '� <br /> � �� — — <br /> �� g W <br /> 4i� o �_— ���/]t,'c/_�'� l l `}� � <br /> x y� Prolect Address(il knownl _ I C�I� I � � ���--�J--I-�. <br /> r4 \ <br /> F-I y Attach lour(4)coPies ol P�ans lor pwposed work� Draw to scale antl note the following as appl�ca5le � <br /> y • Property Lines • Centerlinu cf slreel <br /> H • Indicate Norin <br /> n ry y • Outlme and dlmension5 0l all exisling anA � Show any propOsetl g�atling changes <br /> y�� � prOposed strucWres on Ihe lol • Show measurements � <br /> • Existing and proposed utililics <br /> y Q y DO NOT LVRITE BELOW THIS LIN[ O <br /> PERMIT CONDITIpNS 259•g$�O. � <br /> 1.All calls lor inspeclion shall be made 24 hrs.in advance-phone <br /> f 2.All worM�nall be pedormed in accordance with this permit and wrrent City of Everett Design and Construclion <br /> � ' Slan�.ards and Specilications. � <br /> I 3.f,eil Location Under9round Service 48 hrs.belore you diy.TOLL FREE NUMBER 1•800•424-5555. <br /> � <br /> ��� <br /> -j>�k_� �12�rzr�,q-f -�.�,� ,�-��� � <br /> �- �" <br /> � �-� ���lM ��� � <br /> � �����i �_,-, �/��� �� a <br /> � � � <br /> �,�, ; <br /> ACKNOWLEDGEMENT O�CONDITIONS <br /> . The undersic�ned Dwner/applicant hereby a9rees to holtl�nd save harm- <br /> �1�a ' less �he Ciry ol Everett irom any and all claims fo� damages. cosis. <br /> ' e<penses. or causes of action that may arise because ol installation <br /> and maintenance ol Ihe improvement or olher righpof�way use hereto <br /> applied for and lurther aaree5 lo remove 5ame upCn nolice Irom the <br /> Approved for ConsVucticn �31e City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date Date <br /> APn�oved as Constructed Signature ol Applir.ant <br /> /'�'� WORK AUTHGR�ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> teverettI PUBLICWOFiKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> I w I 3200CetlarStree� BE DILIGENTLY PURSUED TO COP.IPLETION. THIS PERMIT MAY BE <br /> I V I Everett.WA 98201 CANCELLED BY THE CIT\'UPON ANY STOPPAGE OF WOr�K ON THIS <br /> �7J Phone:259�8810 PFOJECT OVER 90 DAYS DURATION. <br />