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i .�-- <br /> � <br /> ��_r � .�-,.;{ I� ���sfi�1 4 �� <br /> �"(� 5/2�3 /lS/ FunucWorkeP �� <br /> Date � ��'���1 <br /> e�aq oeo�.• � i. '-- <br /> AUPlir.alion For <br /> PUBLIC WORKS PERMIT °��°°`°'°„"`�- - -- -_ <br /> ro�.,�F�o s_ . <br /> lcssAnl�� fe�Pa��l S <br /> o.�,,�,:�o�� 5 Zc�?-^� <br /> Prinl or Type Only <br /> x t�"� / <br /> lTl a y Il/, �, ,��, � . �, Y' � . ��n�-� -�( <br /> [�H '�l/i lil �i�i T'��� ,� � � ` �' �.I ��� �� 1 � � �� �I � � I I ,•�, i. r;� <br /> a y y Qµ.�Q1 Mailing Atltlress Cih ' P� � �Q <br /> r <br /> K �� `1 �1'�i `'/�I'1'1!�. _ — <br /> H Cb �Iir,an� Mailmg Adtlress Cily ZiP Phnnc <br /> '� H'�1 tr--- � <br /> Hx y tg'� Descnbe PropoSed Work __ � � f � <br /> [�1 O I�1 <br /> HC <br /> H �g W�j]Y �] <br /> H � �1�y • <br /> a y� Project Address lil knownl ~"��'� ��^������'�'`� A�� l � <br /> � <br /> �"�y Atta[h lour 141 copiCS of Plans lor proposed work� O�aw�o scale and no�e Ihe following as apDlicalNe� e <br /> � • Centedlne of streel ♦� <br /> H • Property Lines V♦ <br /> n d N • Outlme and dimension;nl all exisling antl • Indicate Norih <br /> � [�t+ prOPoSEtl S�ruCtures on Ihe lo� • Show Bny p�oposetl gratlm9 Ch.lnqe5 <br /> [�7 • Existing..�n�,roposetl utildies • Show measuremems /y� <br /> y �� DO NOT WRITE BELOW THIS LINE � <br /> PEFMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. �\ <br /> 2.All work shall be pedormed in accordance wilh this permit and wrrent City of Everett Design and Conslruction ♦ <br /> Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.betore you dig.TOLI i=REE NUMBER 1•800•424-55b5. � <br /> 'e � <br /> ��' O <br /> '� �w <br /> �, <br /> '__ _/ <br /> _! O <br /> �_�_ a <br /> _ � <br /> '�' n.� ACKNONLEDGEMENTOFCONDITIONS <br /> V <br /> '�`f l0 The untler5ignetl Owner,�appGClnt hereby agr¢es t0 hold 3ntl SavO harm� <br /> less Ihe Cdy of Everett from any and all claims lor dama9es, costs. <br /> expenses. or cauces ol aclion thal may arise because ot installation <br /> f�/1 and mamten nce 1 Ihe improvemant or ot�er nght�ohway use herelo <br /> f.�' ' � � 1 4� � r Z — � _ applictl lor n �rthe agrces tc remove same upon notme Irom the <br /> Approved lor Co st �in^ ���e Cdy an iace blic pwpgrry magetl ihereby. <br /> �.:�' 7� ' - � �L � �j G � _ Z I� <br /> FIN ' iN ECTION Date p��� <br /> App:oved as Conslructed �Signatwe o�A cant <br /> WORK AUTHO IZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> e��errll PUBLIC WOFhS OEPARTv SNT 100 DAYS OF DATE PERh11T IS ISSUED AND THEf7EAFTER IS TO <br /> � �200 Cetla�S��ee� BE DIUGENTLY PURSUED TO COMPLETION. THIS PERfdIT MAV BE <br /> Everett.WA 9820' CANCELLED BY 7HE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> Phane.259�B8�J pROJECT OVER 90 DAVS DURATION. <br />