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� y <br /> q� H <br /> � Hy <br /> H�H <br /> tC (] <br /> '�tl �� I <br /> ' 4 , — f Puoi�cworxerormil, <br /> �2: Date S � / fn , J <br /> ^ �I BiEO OeO�-�� <br /> Fj d Application For <br /> �� g PUBLIC WORKS PERMIT `°°:oWFao`°° _ <br /> rnr n ._.SPDD<<eaPaitl S <br /> y y� eam��o o�� 5 <br /> t�� Print or Type Only <br /> Hy <br /> gy <br /> H <br /> "��' F�Z <br /> Owner <br /> Mailing Address City Zip Phone <br /> HO� � <br /> � Phone <br /> Applicant Mailing Address Ciry ZIP <br /> /-/�yN � �n TdbL��--�Q'sSroa / I/IL?d/C n �—�Prnp.� ��,. <br /> Describr. Proposed Work �- <br /> W <br /> Projecl Address(il known) v� � <br /> �� <br /> Attach lour(4)copies o� plans lor proposed work- Draw lo scaie and note ihe following as apPlicable: � <br /> • Properry Lines • Centedine ol streel <br /> • Outline and dimensions oi all exisling and • Indicale North <br /> proposed 5trucW res on ihe lol • Show any proposed grading changes <br /> '�1 • Existing and proposed utilities • Show measurements � <br /> 1 ' DO NOT WRITE BELC W THIS LINE O <br /> � <br /> '�1 PERMITCONDITIONS <br /> 1.All calls lor inspectlon shall be made 24 hrs.in advance•phone 259•8810. � <br /> ' ' 2.All work shall be performed in accordance with lhis permit and current Ciry ot Everett Design and Construction <br /> � Standards end Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> '_1 <br /> 1 1 ]��0 1 GJ �e���� re�u�rP� O <br /> �_I �r k��m Sl��°� ! V� <br /> �'� a <br /> ►- <br /> �' ACKNOWLEDGEMENT OF CONDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold anA save harm- <br /> less the City of Everetl Irom any and all claims lor oama9es, costs. <br /> ezpenses, or causes ol aclion iha� may arise because ot installation <br /> and maintenance ol the improvement or other nght�ol�way use hereto <br /> applied lor and lurther agrees lo remove same upon notice Irom ihr. <br /> Approved lor Consiruction �a�e City and to replace public property damaged thereby. <br /> FINAL INSPECTION �a�e Date <br /> Appmved as Consiructed Signature ol Applicanl <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �7 PU�IICWORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Slreet BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT "dAV BE <br /> �/��TT Everett.WA 88�01 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON 7HIS <br /> Phone:259-BB10 PRO.IECT OVER 90 DAYS DURATION. <br /> �'__'_'__"_ " <br /> ____ ' <br />