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oe�B `" -9C� � <br />AppliCetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />wm�cwen�w, �/•��/��J/��/�,/� <br />Piap oeo� • �(o'� � �w�T <br />v„o�K wm�. re. s <br />muir.e <br />�eu eco� ree v�•a f <br />e+i+ e me f <br />qpplicant MallingAddress Cily Zip P�one <br />Describo Proposetl WorM r�� ���� 1 `` x�� <br />Project ACtlress (il known) <br />Attech low �4) coples ol plans br pm0osetl work - Oraw to scale end nole Ihe following as ap0licable'. <br />• Properly Lines • Cenletline ol street <br />• Outlina and dimensions ol ell existing nnd • Intl¢atc NoN.� <br />propo5e0 slm[Wres on Ihe Ioi • Show any pwposed qraCm9 cnan9es <br />• Esisting an0 proposed ulilities • Show mea5uremeNS <br />PERMIT CONI.!TIONS <br />t. All cells lor inspeclion shell �e matle 24 hrs. in advance � phone 259-8810. <br />2. All work s�all Ee OeAormed In acwrdance with I�Is permil and currenl City ol Everett Deslgn antl Conslruclion <br />SlentlarCs antl Specilicalion5. <br />3. Call Loca�ion Untlerground Service 4B hrs. �efore you tlig. TOLL FREE NUMBER i•800�ii'143555. <br />I'?OI �`�'c c� . <br />S- 22- �o <br />-i�-�SZVV1��-�--� <br />Appmvetl br Consimction Oale <br />FINAL INSPECTION Oate <br />ApproveA ns Consimctnd <br />evcren PUBIICWORKSOEPARTMENT <br />� ffiOOCotlarSireet <br />Evoratt. WA 98201 <br />POone�.259�9810 <br />ACKNOWLEDGEMENTOFCONDITIONS <br />The n- tler5igneE ow0er/tpplic3nt he�eby agie¢S io holtl dntl SavC hp�m� <br />less Ihe City a' Eveeetl Imm Bny antl all claims lar tlamaBes, cosis. <br />e�pensCs, or CBuSes OI aCtiOn ih�t m0y nnse bCtBuse ol inslallat�on <br />antl mainlenonce ol lhe impwvement or ot�er rig�Po4way use nerela <br />aOPlietl lar and luithe� agrees lo �emove same upon noli�e 7mm I�e <br />City nntl lo replace �ubllc pro0etly tlamaBed thereby. <br />SignaWre ol Applicant Date <br />WORK Al1TMORIZED BY iM15 PEPMIT IAUST BE STARTEO WITHIN <br />IBO DAY$ OF OAiE PERMIT IS ISSUED AND TMEREAFTER �S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 6E <br />CANCELLED BY TME CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PNOJECT OVER 90 DAYS DURATIpN. <br />