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Date �� �c: / <br />pppliwtion For <br />PU�BLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work <br />�� o7dL / �:_��.tTc� <br />Add�ess Ciry <br />, n�s�� ,�� <br />Mailing Adtlress <br />t <br />s <br />Project Address lil known) V � 2� � 7` �—� � <br />PuOIK Nofka Pnfm I �� � <br />� �'z 4� U <br />Bioa oect • _ <br />P�C��cKoiwsfee S /��.�_✓ <br />ro�a� F�� <br />� <br />Lesa Pno� Fee Paia S >— <br />9Nanca Oue S �� <br />Attach lour (4) copies of plans lor proposed work - Draw to scale antl note the lollow�nn as appiicable: <br />• Properry Lmes • Centerline ol street <br />• Outline and tlimensions ol all eaisling and • Indicate Nonh <br />proDosed siructures cn the iot • Show any oroposed yratlmg changes <br />• ExiSticg antl prOposetl utditie5 • ShOw measurement5 <br />izi .3w»-.1s5.3 <br />Phone <br />PERMIT CONDITIONS <br />1. All calls tor ins,.ectwn shall 6e made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be performea m accordance wdh this permit and cur•ent City of Evcren Des�qn and Construcuon <br />Standards and SpecJications. <br />3. Call Location Undergrouno Service 48 hrs. belore yo� dig. TOLL FREE NUMBER 1-800-424-5555. <br />� ,�c.0 /�L'�'s'�/.�o i�.Cf��s' Jf,'i��: <br />/ j� —�� �(TjG�i/�J <br />/ �J -�'Y �r/ %�— <br />Approved as Constructeo <br />PUBLIC WORKS DEPART'.1ENT <br />�200 Cedar Street <br />Everen. WA 98201 <br />Phone:�59�6815 <br />� <br />�CKNOIVLEDGF�dENT OF CONDITIONS <br />�J <br />� <br />� <br />0 <br />� <br />!he undersigned owner/applicanl hereby agrees to holtl and save h;arm� <br />less ihe City ol Everett irom any and atl claims for damaqes. rosts. <br />expenses, or causes ol aclion ihat may a��se because of installahon <br />dntl m0inlenanCe C� ihe imprOvem@nl or othCf righFaf-wey u5e herel0 <br />apphed for and lurlher agrees to remove same upon notice Irom Ine <br />Cily antl to replace Public property tlamagetl ihereby. <br />IVORK AUTHOR12"LD 6Y THIS PERAtIT 61UST �E ST�1RT[D WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEP[AFTER IS TO <br />OE DILIGENTLY PURSU[D TO COtdPLETION. THIS PEHIdIT MAY BE <br />CANCELLEO BV THE CITY UPON FNY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DUFATION. <br />� <br />�. <br />b: <br />