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�� � <br /> o �x <br /> C N <br /> yH �n ...� . , <br /> H r� /� ) <br /> H���-+ Date f0'Y��1 P„���,�wo..�P�,^�y�-�{—T����Q <br /> 1! O Dine oeo� • J�-l.I—�LV`FL.���l.�. .. <br /> H �1 Application For <br /> °tiH PUBLIC WORKS PERMIT `°°'�°�°"s`�° --- — -- _ <br /> ,o�a�F« s- <br /> H <br /> xx LessAno� FerPa�o 5 <br /> Op eai.,�ceo�c S <br /> H d Print or Type Only <br /> ��' g <br /> zy l� � �� (�����R ��, ��a�� �v� �� ����07 <br /> Owner Maihng AAtlress C�ty 7ip Phone <br /> � HH <br /> g y H Ll �t — <br /> n�y Phonc <br /> � qpplieant Mailin9 Address City Zip <br /> 1 �� y Describe Proposed Work �� �I� � F� ���� � ' " ` "� <br /> W <br />� ��, F.. <br />, project Adtlress lil knownl <br /> Attach lour I4)copies ol plans lor proposr.d work� Dmw Io swle and note the followln�as applicable�. � <br /> • P'operty Lines • Centedine ol street ♦A <br /> • Oulline and dimensions ol all eaisting and • Indicale Norih V� <br /> proposetl slructures on the lot • Show any proposatl gratlmg changes <br />� • Ezrstmg and proposed utildies • Show measumraents M <br /> W <br /> �O NOT WRITE BELOW THIS LINE O <br /> � '�1 PERMITCONDITIONS <br /> 1,A�I call,loi inspeclion shall be made 24 hrs.in advance�phone 259•$810. � <br /> 2.All work shall be pedormed in accordance with this permit and currenl City ol Everet�Desiqn and Construction <br /> '�' Standards and Specilications. <br /> a-i <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBEH 1•800�424•5555. � <br /> 1' � / 7 , /J � O <br /> � �� � > <br /> ��� /�yn,/Jra,c:�/(/c°�/-P_��(�c.S�-ot' i ) /?— � <br /> � � ��.'�v�zs,���= <br /> �-��-�� � <br /> -� O <br /> ►- <br /> - a <br /> � <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> ' , The undersi9ned owneUapplicant hereby agrees to holG and save harm� <br /> 11 Iess the City of Everett Irom any and all claims tor damages, costs. <br /> � enpenses, or causes ol action that may arise because of inslallation <br /> and maintensnce ol the improvement or other righ4of�way use hereto <br /> �---- applied tor and luriher a9rees to remove same upon notice Iwm the <br /> Approved for Construction ���� Ctty and lo replace pu6Gc D�operty dama9etl thereby. <br /> FINAL INSPECTION ���e Dale <br /> Appmved as Consirucled S19nature o�Applicant <br /> WORK �UTHJRIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br /> � 3200CedarSlreet BE DILIGENTLI' PURSUED TO COMFLETION.THIS FERMIT h1AY BE <br /> Everelt,WA 99201 CANCELLED BY THE GTY UPON ANV STOPPAGE OF WORK ON iH15 <br /> Phone:259�8810 pROJECT OVER 90 CAYS DURATION. <br />