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Pubhc Wcrk�Pe�mll• �✓ J'" / <br /> Oale /7 '� -5 eieo o�o� • — <br /> Applfcatfon For <br /> CubbcWa�ake s /f� <br /> PUBLIC WORKS PERMIT T�,�1fe� <br /> lee��pC�Iee Po�d s `'� <br /> Be�ence Duc s <br /> Print or Type OnIY ���,j�b <br /> r�c+8 .l�n�o.noP J�-. C-�cscn-r ;'�i?o3 _�S �- 6`.? '13 <br /> � �t.' �..v,.'��,C[' ZIP Phone = <br /> Mailing Address ���y � <br /> OWnef ""� <br /> r. <br /> .�/�e�^C-� � <br /> /� A1 C.�...ni:•a_. Ciry Zip Fhone .. <br /> App11Ce�� Mailing Address <br /> � ...-. <br /> l � C%,�f� --1 T <br /> //G�.S%/7�/ L j t.c O �� � ..--i <br /> Describe Proposed Work � �,� G—�/� �� N m <br /> �C <br /> ���C � o <br /> ------- ■ , . m o <br /> W` �� <br /> ��p/ �J� S�r9<< //v6�'�.�f�c` f�" _� <br /> Prolect Address(il known) �� m <br /> Ilcable: .O 2 <br /> Altach lour�4�copies ol olans for vroposed work•Draw to scale end note�CQ^�,eW�ne ol Ipeet � � _ <br /> • PropertY Lines � Indicate Norih <br /> • (lulline anA dimensions ol all ezisting and � $how any proposed grading changes �t�i� <br /> proposed s!ruc�ures on the lot � Show measurements � 'n <br /> • Exlsling and proposed utilities �� <br /> DO NO�WRITE BELOW?HIS LINE � -� <br /> m� <br /> PERMITCONDITIONS � N <br /> 1. All calls for inspecllon shall be made 24 hrs.in advance-phone 259•88�5� 8 m <br /> � <br /> 2. All work shall be Performed in accordance with this permil and curreN Ciry ol Everetl Design and Construc ion � <br /> Standaids and Specifications. � N <br /> 3. Call Lor.alion Underground Service 48 hrs.belore You dig.TOLL FPEE NUMBER 7-800•424•5555. �m <br /> � p O • p <br /> � ��, ��/�7�1< ��/ <br /> / �-:� ""i <br /> x <br /> � D <br /> z <br /> J <br /> � _ <br /> U <br /> o Z <br /> � <br /> � <br /> a � <br /> m <br /> A:KNOWLEOGEMENi Of CONDITIONS <br /> The undersigned owner/apPlican�hereby�g�ees to hold and save harm� <br /> less Ihe Cily ol Everett Irom any and all clafms lor damages, costs. <br /> expenses, or causes ol action ihat may nrise because ol Instalinlion <br /> ����-' / .v.� and maintenance ol the improvemenl or othr� righl�obway usa IIPfP�O <br /> ��-����� � °'v anPlied lor and lurlher agrees to remove same unon notice Irom Ihe <br /> ���" Dale Cily and to replace public properly damaged theieby. <br /> nppioved fo�con6tiuc1lo /- <br /> ��� � �J ��e /� - /7j4�j _ <br /> a. ,��:^���— i.�/ <br /> Datc <br /> f. INSPECiION Signature oi�pPlican� <br /> �pproved asConst�octed Wp��K q��T�{pq�ZE� BY THIS Pf_RMIT MUST BE STARtED WITHRJ <br /> rcrm❑ PU�LlC WORKS DEPARTMENT 180 DA'f5 OF DATE "-LRMI7 IS ISSUED AND THEI7EAFIER IS TO <br /> � 32D0 Cedar;I�er.l O[ DIUGENTIY PURL7ED i0 COMFLETION. THIS PERMIT !d�V RE <br /> Everelt.W�yg20� GANCELLFD BY TNE CITY UPON ANV S10PPAGE OF WORK ON 7 NIS <br /> Phone�. 259-B�i15 PROJECT OV[R 90 DAYS DURATION. <br />