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Date ��. ��.?� .� ��,�..�, w�,•�s�,...�„�. -- —. <br /> aina Oen� • —._— — — . <br /> " ' Applicahen For <br /> PUBUC WORKS PERMIT P"°ro,.�`°` :_ -- - <br /> les nui fee Paia S_— — <br /> r�.,�,..n��� S— <br /> PriM or Type Only — <br /> �N,�p� Maihng AAtlress C��y 7_in Phone <br /> � �irl�..� 1�n a1,� eolCf �I d_Q��� " u.�1orn�4� �98�/0 `l � `�I Slo <br /> AppGcant Madmg Aadress Crty LP Phone <br /> Describe Proposed Work _� ��` L`" — — <br /> W <br /> _�i� �� c�� � - ' �.. <br /> Pro�ect Adtlress lil kno�enl , <br /> Attach low(4) copies ol plans�or propose.d work� Draw to scale antl note Ihe lollowing as applicable: � <br /> • Property Lines • Center4ne ol sVeet � <br /> • OutLne and dimensionc ot all eKisting and • Indicate Norih <br /> propos?tl structures on ihe lol • Show any proposed gratling changes <br /> • E��shng anA proposed utJAies • Show measurements � <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT COND�TIONS <br /> ?.A�I ca�ls lor inspection shall be made 24 hrs.in advance-phone Zb9•8g10. � <br /> 2.All work shell be peAormed in acwrdance with this permit and current Ciry of Everett Design and Conetrudion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> , -S- ' o F Lf,�i�5 �f�'i/�'� ���/�_� O <br /> � <br /> �'uTi%�L� l�� - �- �L�'c��'�,�',�i"/1�� � <br /> �,�'��i S' . ��C`s�'�/7 jL i,�/�'J�E� //L�/� � <br /> ,�' � . ��'�'�_, �� •=�, , %.�-� c r �y ��f- 0 <br /> � � <br /> '�'�-��`�/,E� �'��73' � , ,_.��- a <br /> � � �%���-; � i�, <br /> � �,�jt,�_�S �'�'/5`i���L �<=��` <br /> ��� � �v 'S///��GACKNOWLEDGEMENT OF CONDITIONS <br /> i <br /> .������'�G �� ��/ "%hetindersignedowner/appBcantherebyagreestoholdandsaveharrm <br /> less �he Clly of Everett Irom any and all claims fur damages. costs <br /> expenses. or causes of actlon that may arise because of mstallat�on <br /> ��1 / ,..� d maintenance o� Ihe improvement or olher right�obway use hereio <br /> a h an I rlher agrees to remove same upon noLce Irom ihP <br /> Appr�, �Or�(,`on �� c�ion �� Da� ity a � p - public properly damaged ihe�eby. <br /> FlNAL INSPECTION Date <br /> 17'�i �Z � 2�' <br /> App�oved as Consirucled S�gnature 1 A phca t Date <br /> WORK AUTHOR12[D V THIS PER1 IT MUST BE STARTED WITHIN <br /> evprPtl PUBLICWORKSDEPARTMENT 1g0 DAYS OF D4TE PERMIT IS IS [D AND 711[RC-AFTER IS TO <br /> � 3200CetlarStreel gE DIUGENTLV PURSUED TO COMPLETION TFIIS P[P�dI7 tsnv BC <br /> Everetl.WP 99201 CANCL�IED BY THE CITY UPOh ANV STOPPAGF. OF WOf7K ON iHIS <br /> Phone-.259�8810 pROJ(CT OV[R 90 DAVS DURATION. <br />