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-������� . . <br /> ����•�� � / 4�pP�TWo�hSP��yywa,._j <br /> ApPlicalion For ����q ocn� . —'.��j_����� _ <br /> PUBLIC WORKS PERMIT ����������w�,««e - ----------- <br /> ,o������ s_ <br /> l�•SaAp01 FnCPeN S <br /> Print ar Type Only t_,,��=�o�� S <br /> ����1 nE`'.`�� T�1�L��XI 71�`'F'. -'��'D� %���-��'_ �► �'l(�'�, - <br /> Owner Maihng Atldress ��� <br /> Y Z�P Phone <br /> t'L 61 <br /> Applicant Mailing Atldress City Zip Phone <br /> �— ,�..,�^ y'�� <br /> DescribeProposedWork ,1}� dC� ,l I( �Y^ � � '� <br /> �1 ^ W <br /> Project Address�if known� _. r . , � <br /> Attach four(4�coD�es of plsns lor proposetl work-Draw to scale antl note th�following as applicaL•�a- _ <br /> � Properry Lines • Centerline af street � <br /> • Outline and dimensions ol all existing and • Indicate Norih <br /> proposed structures on�he lol • Show any proposed gratling changes <br /> • Eaisting and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspection shall be made 24 hrs.in advnnce•phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and curren�City ot Everett Design and Construction <br /> Stenderda and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBFR 1•800•Q24•5555. � <br /> �i /�.--� �)z ivl i T �� � �l l�C'�7 O <br /> , ,1 <br /> � � E�� ��'1��CGc��. � <br /> � z - 1 - �`r � <br /> � <br /> a <br /> �CKN06VLEDG[MENT OF CONDITIONS <br /> Thr untlersi�7ned owner/apphcant hereby agrees to holtl antl save harm� <br /> less the Cdy ol Everett Irom any and all claims lor damages, costs. <br /> expenses. or causes of actlon that me.y arise because ol installation <br /> antl maintenance of ihe improvement or olher right�obway use hereto <br /> apphed lor and lurther a rees lo remove same u on notice irom the <br /> Approved lor Consiruction Dale 9 p <br /> City and to replace puBlic property damaged thereby. <br /> fINAL INSPECTION Date <br /> Approved as Constiuc�ed Si9na�ure ol Applicant Dale <br /> everrlt PUBLICWORKSDEPARTMENT WORK AUTHORI2ED BY iHIS PERMIT MUST B[ STARTED WITHIN <br /> � 3200CedarStreet 180 DAVS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 8E DILIGENTLV PURSUED TO COMPLETION. iHIS PER�d1T MAV BE <br /> Phone:259�8810 CANCELLED BV THE CITY UPON ANY STOPPAGE GF WORK ON THIS <br /> PROJ[CT OV[R 90 DAYS DURATION. <br />