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} <br /> .h��.l' /� r„�y . .. PepM1CV:o�xaParmn(��.—_ __ <br /> ...f C. .� Ci <br /> Date I piag Dept . � � � <br /> Applicalion For <br /> PUBLIC WORKS PERMIT "°°'�°,"°'"„`° <br /> Total Fer 5 <br /> LcuAo��Feo Pma 5 <br /> BdIT�CI!DUP, S <br /> Print or Type Only rn nnCTl�� _ � -Iq-� <br /> ��x /�L�I� 1�E � ' '� I� 'C' � , � , c � S'-L L � <br /> 1 1 ����� L_�cv, ,, � i X�a F� rs��C� � ,�_� , l ll � <br /> �y y � Owner Mailinp Adtlress Cily Zip Phone <br /> H �3 <br /> H <br /> K n Mailin AddrosS Cily Zip Phone <br /> y� qpplicanl 9 <br /> � CA H r1—,� /- <br /> y Z� Describe Proposed Work ���� � , ' � `� '` �I� <br /> xo <br /> Hl7 <br /> ��g W <br /> z y� " �' '' ll � <br /> Proiect Address lif kno•.vnl <br /> � H y Altach lour(4)copies ol plans lor proposed wo�k� Draw to scale and note the lollowing as app6cabie�. �� <br /> �j y�..i • Pwperly Lines • Cen�erline ol sireet ♦^ <br /> O C7 U1 • Oulline and dimensions o1 all existing antl • Indicate North V� '� <br /> � �ty propOsetl SIrUCIureS on ihe IoI • Show any propOSCA 9radin�Changes <br /> � y y • Eaistin9 antl proposed utilities • Show meacurements M <br /> y �y DO NOT WRITE BELO\N THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advanco•phone 2S9•8810 � <br /> 2.All work shall be pedormed in accordance with Ihis permil and wrrent City ol Everett Design and Construclion <br /> Standards and Speciliwtions. <br /> / 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � � �/� �/` <br /> ' {� �o(1� �I�91r F�( ���V/K lT Ic-r-��l � V� O <br /> �+ � <br /> �O � <br /> ���� N <br /> � - O <br /> _ � <br /> 3 -i2- 9a a <br /> �t� <br /> y ACKNOWLEDGEMENT OF CONDITIONS <br /> ;( � The undersigned owneqapplicant hereby agrees to hold and save harm� <br /> less Ihe Crty ol Everett Irom any and all daims br damages, costs. I <br /> expenses. oi c.uses o� action Ihat may arise because of installation <br /> ' '.�' and mamtenan[e of Ihe Impwvement or other ric�ht-ol-way u5e hereto <br /> �„� applintl �or and lurther agrees to remove same upo� nolice Irom ihe <br /> qpprovetl br Construclion Date City and to repiace public pwperly damagetl ihereby. <br /> FINAL INSPEC710N Date Date <br /> qpproved as Conslructed Si�nature ot Applicanl <br /> WORK AUTHOFiIZED BY THIS PERMIT MUST BE STARTED WITHIN I <br /> everetl PUBLICWORKSDEPARTMENT 180 DAYS OF D�1TE PEFMIT IS �SSUED AND THEFFAFTER iS T� I <br /> � 3200CedarStreet BE DILIGENTLY PURSUED 7Q C01+1PLETION. iHIS PERh117 61AV BE <br /> EverctC WA98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phonc 259�8810 PNOJECT OVER 90 DA�'S DURATION. <br />