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'� � <br />DateL_]-.-�-' <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ess <br />, I ruee<won�Feim���= <br />eiap oeo��• <br />woicwo�.• f�� 5 <br />r�,.�,.. <br />�..�, o„ ��. P.a s <br />a.�.��.o,. s_— <br />Phone <br />�escribeProposeEWo�k ,'��`�1�t ��'�rtfKin2 ��%�X��n <br />pwicct Address lil knowN � � <br />Altuch lour (4) co0�es of plans lor pmposed worh � Draw lo scolo and no�e � CentetlinO ol Slr�ee'1 able: <br />� Propr�Iy Lines • Indicate Norl� <br />• Oulline and tlimensions cl all axi5tin0 @^d � S�ow any proposetl gratling cMnges <br />proposed SlmcWres on 1he lol � Show meocuremenis <br />• Eelstinp a�d proposetl Wililies <br />PEFMI7 CONDITIONS <br />1. All wlls lor Inspection she�� bo matle 24 hrs in advance � phone 259•8815. <br />p. All work sholl be Pedarmed in eccorAance wi�� ihis pe�mil and wrrenl City cl Everett Design antl Canslmction <br />Standards and Specilitaiions <br />9. Call Lowtian Undcrprountl Service 48 hrs 6eloro you tlig. TOLL FHEE NUMBER 1•800•4245555. <br />i�t'��{�� �'�'C-;i_�i���� <br />nppmvetl lor Consimction Dale <br />FINAL INSPECTION Daie <br />�I�nioved ns Consimcted <br />�.�.�.��.i� PUBUC WOPNS DEPARTMENT <br />� 3:J0 CeAar Street <br />[verelt.lVA 98201 <br />Pnanc: 2G&ftt31 6 <br />�/��/���. <br />.-.7��,; <br />,�,� <br />Z <br />O <br />N <br />O <br />a <br />ACKNO\NLEDGEMENT OF CONDITIONS <br />The undersiqned owner/applicanl he�eby agiees lo �old and save hnrm- <br />Iess iho C'�ry ol Eve�ett Imm uny ond all claims lor damages, cosls, <br />expenses. or causes of action Ihat may erise oecause of ins�a��n�ion <br />anE maintenance of Ih�'. �mprovement or olher ny�boFwaY use hereto <br />applied lor a�d lurther agrees to remove same upon notice Oom Ihe <br />Ciry and lo �eplace public proper�y damagad Ihereby. <br />SignaN�e of Applicant Dale <br />lAef'�DAVSTOO OIATE PERIdIT ISEISSUED AND HER AFTEP ISHTO <br />BE DILIGENTLV PURSUED TO COMVLETION. THIS PERMIT MAY BE <br />CANCELLED BV TNE CI�i' UPON ANV STO�'�AGE OF WORK ON THIS <br />PFOJECT OVER 90 OFYb 9URNTION <br />