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M�� <br /> �� � � <br /> A � x <br /> C, H <br /> � � � � � v��m�c v.o,�s rc����i. ) <br /> ''� y � Date �-� �- �� ,-�/ :-�, J �-�c� <br /> nm9 Deo� •��-_f_.. .:��lL=.. ,� <br /> �H � ApPlication For � � � <br /> f/1 N _--- <br /> y`� pUBLIC WOiiKS PERMIT °°°^°w°"°`�� <br /> z r��.,�Fe� s <br /> �`� Q � ��•saanoi �revma S — <br /> ro <br /> O H n.,�,,��.�o�� S <br /> �� g Frint cr Type Only <br /> 4]Y � <br /> zH�F� H y r�-r�E�1r1��L� "��a ��7%1 <br /> �y Owner r Ma�linc�Addiess Gty Z.P Phone <br /> H <br /> C� Utn <br /> �jG r Applicant Mailin9 Adtlress City Zip Phone �' <br /> C�7 <br /> H O Vi ,1/�I �` IV^L!�-J,I /�{/�l <br /> Describe Proposed Work � I �'"'"/ -�1` '' ` •�� ��/����r (/L ' � I <br /> i <br /> �1 � n �I' %—�7 � �li <br /> ProlectAddresslilk��own) I ( 1��� � � � �� <br /> Attach lour(4)copies ol plans lor proposed work� Draw to scale and note the lollox�ing as appGca6ie: e I <br /> • Propeny Lines • Ceniedine ot slreet /^ ' <br /> i <br /> • Outline and dimensions ol all ex�stln9 anA • Indicate Nor�h V� <br /> prOposed SliuClur25 on the lo: • Show any proposed 9radin�chan9es <br /> • Existing and propcsed u�ih�ies • Sl�ow measuremeNs /�A <br /> i/���. DO NOT WRITE BELOW THIS LINE O <br /> i�_ <br /> , PERMIT CONDITIONS <br /> 1 , 1 All calls lor inspection shall Ue made 24 hrs �n advance�phone 259•8810 � <br /> 2.All work shall be pertormed in accordance wilh Ihis permil and current City ol Everett Desi9n and Consiruction <br /> . ._� Stantlards and Specifications. � <br /> �_� 3.:all Location Underground Ser�ite a�hrs.belorr.you dic�.TOLL FREE NUMBER 1-800•424-5555. �' I <br /> t� <br /> ' '�� <br /> � �'��n-r ,1��r��, � <br /> ! --' �z����-f_ � <br /> ,_ ,�,_ �� cn <br /> o=�_� o � <br /> _ a �� <br /> ��_ � <br /> � ACHNUWLEDGEMENT OF CONDITIONS <br /> I ��. The undersigned owner/applicant hereby agrees to na4�and savc harm- II <br /> l� less ihe City of Everet� imm any and all claims for Aa�oages, costs. <br /> expenses, or causes ol aclion that may ari5e because ol inslallation . <br /> and mamtenance of �he improvement or other n9hbob�tay use hereto <br /> applmd for and lurther a9rees to remove same upun nolice Irom Ihe <br /> Approved lor Consiruc�ion Da�e Cdy and to replace public property dama9ed Ihereby. , ' <br /> FINAL INSPECTION Date � <br /> Approved as Consiructed Si9nature o1 Applicant Dale i <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED IVITHIN <br /> evrrrlt PUBLICJJGRKSDEPAPTMENT 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO ' <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERIdIT h1AY BE <br /> Everett.WA98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone'.259�8810 PROJECT OVflR'�� DAVS DU��110N. <br />