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Date�Q��89 <br />ApP�ica�ien For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�e <br />ApplicaM <br />ng <br />Meding Address <br />Cdy. <br />z�n <br />� <br />,-�.�..�,.,o,.sP�,�,��. e9/14zz _ <br />m„� o„oi . —.g9/—L3 2 �/S <br />Pul�lif lVJ�15 �i`C <br />,o�.,�F�.� 5-- — <br />less Ann� Fec Pav1 5_ - <br />palancn0ue S �� —_ <br />G <br />Phone <br />Descnbc Proposed Work ��W� — <br />Prolect Address (il A�ownl <br />5 5 I� A-1- 6 SovTi T}+ i r� 1� A�"e <br />i.ttach lou� I�q copr' �1 plans lor proposed worh � Dra�e I�� sc:de antl nolr. Ihe lollowing as applicable�. <br />• Property Lines • Cenlerline ol s�rec� <br />• Outline and dimensions ot all exishng and • Indicate Norlh <br />proPosetl siruc�ure5 on Ihe IOI • Show any prJposed 9radirg changes <br />• Ex�si���9 �nA proposed utildies • Show measurements <br />ApprOvedlOr <br />A.=" <br />Approved as <br />everett <br />e <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with ihis permit and current Cily ol Everelt Design and Conslruction <br />Standards ard Specifications. <br />3. Call location Under9round Service 48 hrs. before you diy. TOLL FREE NUMBER 1•$00•�i2��-$$55. <br />,r1 <br />PUBI.IC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Evcrett. WA 98201 <br />Phone:259�8810 <br />:o-. <br />ACKNOWL[DG[MENT OF CONDITIONS <br />W <br />r <br />�w <br />_ / <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned or:neVappllcani hereUy agraes to hold and save harnr <br />Iess the City ot Everetl irom any and all claims for damages. costs. <br />eapenses, or causes ol action Inat may anse Uecause ot installation <br />and maintenance of the improvement or olher righl-ol�wdy use hereto <br />applied lor and lurther a9rees to remove same upon notice irom the <br />City and to replace public properry damaged thereby. <br />� / �/.%' " / i�iv��!✓�� <br />�Ime ol Applicant , Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITIiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION, <br />