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�� 5 <br /> O� x <br /> �Hy . <br /> y� H <br /> �y� Date I�`6D •�[,..;,,'f� �/�G.a.�^ v,�ei��wo,�.v.�m��. _ Ut//�—�CLi��/ <br /> 1� / �7 � binp Deo� � ��1��_�—/. <br /> Z <br /> ApolicaUcn For <br /> ��d PUBLIC WORKS PERMIT ��°°°�w°��°��° ---- - <br /> o H ro„��e. s- — <br /> H� g lessnnoi(ee Pn�a S <br /> M• n eain�ce oue S�_ <br /> y Print or Type Only <br /> ["y <br /> �y � �'��}���, � a�I�in .1 P i �� <��D I �Ct�i�i G ��re� �� ��9-9��� <br /> �y O�.vner MaiNn A dr City Z�p Phone <br /> � �� �rti�.I�(1��'1 �Rgl � � '�(1I 1�ir��/p1 � a-��L,3 <br /> App cant Medin Address itv Z� Phone <br /> �i� /����1�1 �1�l�/1 /1 <br /> Descnbe Proposed 1Nork �� l L Jf�l y? 'LbL-�� ! � �� <br /> W <br /> Prolect Address lil knownl � !—Z(�� G � <br /> Atlach lour Inl copies ot plans�or proposetl work- D�aw to scaie antl nme the foilowing as anP�iwble: � <br /> • Property Lines • CenLrhne ol street /A <br /> • Outhne and d:mensions ol all ensbnq antl • Indic.ate Norih V� <br /> prOposed 5tructure5 on the IOI • Show any proposed gratling change5 <br /> • E•isting and proposed utJiGes � Show measurements � <br /> ij DO NOT WRITE B[lOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> f�1 t.All calls for inspection shall b� �nade 24 hrs.in advance-phone 259•8810. � <br /> 2.All worY,shall be peAormed in accortlance with this permit and current City ol Everett�esign and Construdion <br /> Standards and Specifications. <br /> ��' 3.Call Lowtion Underground Service 48 hrs.be!ore you dig TOLL FREE NUMBER 1-800•424•5$55. � <br /> 1 �. ��,� cy�vu��j_���s � � � � -z� -�'� O <br /> 1 '/� <br /> — <br /> �1 V) <br /> ►i , a <br /> '�' ACKNOWL[DGEMEIJT OF CONDITIONS <br /> The unde�signed owneqapplicant hereby agrees to holA and save herm- <br /> less the Gry ol Everett Irom any and all ciaims for damages. costs. <br /> �//� f expenses. or causes ol aclion Ihat may arise b¢C2use of installalion <br /> / / /�I / and main�enance oi Ihe �mprovemenl or other nght�ol�way use here�o <br /> � applird lor and lunher pce �to refiove same upon notice �rom the <br /> 9d0�oved I Cons cticn Date City and to replace pu n er dama d thereby. <br /> i � �7 �I <br /> /.+ /, /'�'f� �s w <br /> FI L WSP[t;710N Date 1. — <br /> ApprOved'd5 ConS�rucled �tute nl ApPliCan� �� t <br /> rvrrrtl PUBUC WGRKSDEPARTMENT �K AUTHORIZED BV THIS PERMIT MUST BE STARTED WI7HIN <br /> O 3?oOCeaaiStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA98201 BE DILIGENTLY PURSUED TO COMPIETION. THIS PEFMIT MAV BE <br /> Phone:259�Atl10 CANCELLED BY THE GTY UPON ANV STOF'PAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />