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�_„�. <br /> � � �' , <br /> ,� � x <br /> C, H <br /> ? H fn <br /> C <br /> H H � <br /> � H � Date � �����`' �„���,��vo�.,����m,�. <br /> "�4 H '� r,�aa oon� • � /9</G s� <br /> � H Applica�ion Por <br /> PUBLIC �'VORKS PERMIT °°°°""°`"„`° <br /> � �� To�a�Fce 5 . <br /> �t� <br /> d �cu Ap01 Fea Fa� S <br /> o.,i,,,�.00�� 5 <br /> �-�'' � � Print or Type Only <br /> �1]V �] <br /> H C <br /> � H <br /> H H ,t,�.c e.,.:_._t ��-+�. J.Z� .{: (�,�-L:.� i_? t / C'-r--�'.�t.... i f 2 i'/ .� S:�_G .-'e�... <br /> C7 p� � Owne� �tailing f.dd�ess City Zip Phone <br /> O H <br /> C] C7 fn <br /> �� r ._ .,� <br /> z y� qpplicant • Mai6ng Address City Zip Phone <br /> HOtn <br /> ' - %c.C- -�i'�rv <br /> Describe Proposed Work — <br /> �j � W <br /> ProlectAddress�i� known) _% 3Jn v/(' 'E`-+� �� - /f �/� � <br /> Attach lour(4)copies of plans lor pwposed work� D�ew to scale antl note the lollowinq as app�iwble: � <br /> • PropertY Lines • Centerline ol street ♦^ <br /> • Outline and dimensions ol al!existin9 anA • Indicate North V� � <br /> proposed slructures on the�ot • Show:my proposed 9radin9 chan9es �• <br /> • Eaistion antl Froposed utilities • Show nie2surements /M �i <br /> W <br /> � ��'� DO NOT WRITE BELOW THIS LWE O <br /> PERMIT CONDITIONS <br /> 1 ! I.All calls lor inspection shall t=made 24 hrs.in ativance-phone 259•8810. � <br /> �_ 2.All work shall be pedormed i..accordance with ihis permil and current Gry of Everett Desi9n and Conslmction <br /> ' Standards and Specilications. <br /> � �� 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � , <br /> -� � V������K� �� �� � <br /> �-, c 5�--�c_ <br /> I ��� ��� vv1`E_� <br /> ' � - ���- � v �' <br /> ,-�_� _- - -- --� � <br /> O <br /> ,-_ �l. <br /> __ <br /> � <br /> I �r. ACKNOWLEOGEMENT 0t-CONDITIONS <br /> 1 f t �- Tnc undersu�ned owner/appiicant hereby agrees to hald and save harm- <br /> � — less Ihe Ciiy of Everett Irom any and all claims lor dama9es, costs. <br /> expenscs, or causes ol adion Ihat may arise because of ins�allation <br /> and malntenantc o1 Ihe improvement or olher ri9hCol�way use hereto <br /> applied lor anA Iwlncr ayrces to remOve same upon notice Irom Ihe <br /> Approved lor Conslruction ���e City and lo replace public properry damaged ihereby. <br /> FINAL INSPECTION Datc <br /> Approved a5 Conslructed Si9naime ol Apphc�nt �i1�� <br /> WORK AiITHORIZED BY THIS PERMIT MUST 8E START[D WITHIN <br /> evrrrtt PUBLICWORKSDEPARTI.fENT 1B0 DAYS OF DATE PERA7IT IS ISSUBD AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COP.1PLETION. THIS P[RM1IIT �.1�Y 8G <br /> EverelL WA9B201 CANC[LL[D BY TH[CITY UPON r�NY STOPP.IGE O�IVORK ON ililti <br /> Phonc 259-8810 PROJECT OVER 90 DAYS DUF�TION. <br />