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oate z � 'H- i« Y 3� •2.9 • 5 <br />Applbatlon For <br />PUBLIC ORKS PE�,�Tin�r, S <br />Print or Type Only � $ $ $ $ $ 63 $ b," $ $ `'�', <br />.. � ������� � �� <br />PUEI¢ Wor1u ParmH � 9�08� <br />ewo o.n• 43�5!' L <br />roaK wonu v« <br />ranF�. • <br />uu �op� c« wia i <br />' �� <br />B�N�a ou� <br />� <br />����°�°������������ <br />Appll��nt <br />DNCMb� Propo�ad Work Nar Nou sc_ <br />Prolect AddroN (H knownl <br />Atlach four (4) copiss af Ol�ns tor proposed work • Drnw to acale antl note the followinp as applicable: <br />• Prop�rty lin�s <br />• OuMin� �nd dlm�nsions ot �II szi�tinp and <br />propaed atructuros on the tot <br />• Exittlnp �nd propoted utllkks <br />• Centerline ol strost <br />• Ind�ute NOAh <br />• Show �ny propoaed qradinp c��npea <br />• Show maasuremenb <br />PEpM1T CONDITION8 <br />1. All aM for Impscllon sh�M bs m� 2� nn. In �dwncs • W+ons 2b�10. <br />2 AII wprk �h�q b� p�rMrm�tl in �awrd�nw wIM thb p�m�k and cum�nt CRy of Everotl Detq� �nd Co�atnutlon <br />g, Cap �upllpn� Undsr�proa �iW 8ervlos �8 hr�. bsfo� you dip. TOLL FIIlE NUMlE111-90G424b6db. <br />`4. G� tI 339 - 7403 'tD S�'��CI✓ IG PfL� 'GOV� 5`�PtJG'�j'W� M.e�btv� <br />w ii� �b6T� ��la�k.s ins��' (�sr�dM�v►t,w� d�w� <br />a��u,cd t� ed-r �►�+ at. <br />5. Gonnt.�� <br />�V Kl+l�7 O� <br />Cd�.K Gn. <br />P�.�.�-c.�. 3 -q-�+- <br />Apprrned for Conatruction Date <br />_9l,,� f•�s• sr <br />FINAL INSPEGTION Date <br />Approved ss Conetructed <br />� PUBLIC WORKS DEPARTMENT <br />i 9200 Ced�r Strs�t <br />' Ev«slt WA 98201 <br />� PhoM:2648810 <br />St� se�..+r-,�. <br />ACKNOWLED(iEMENT OF CONDITIONS <br />W <br />H <br />� <br />� � <br />�': <br />� <br />� <br />O <br />a <br />The undersigned awner/appliCent hereby apreee to hold and eeve harm- <br />less the City of Everett trom any and all claima lor damapea, coata, <br />expenses, or cauaes of action that may erlse bscauee ol inetalletion <br />end maintenance of the imp�ovement or other ripht•of•way uae hereto <br />applied for and further aqreea to ramovs s�me upon notics from the <br />City and to replece publiC Droperty damaped theroby. <br />���� ��� <br />ignatwe of AppHunt Oete <br />WORK AUTHORIZED BY THIS PERMIT MU3T BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIOENTLV PURSUED TO COMPLETION. THIS PERMI? MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPA�E OF WORK ON THI3 <br />PROJECT OVER 90 DAVS DURATION. <br />