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Date_— �,�:�. �,.,..��..,.,,� . �?� �nG� 1., <br /> ApPhc.11icn frn Iono Den� • _______"_ <br /> PUBLIC WORKS PERMIT �'°^;�W�a��°°S= _ <br /> less nnnl fnn Pwi� S_ __. . <br /> m�.� ,.n�„ S <br /> Print or Type Only — —___ <br /> �`�iv¢ As.fi:d 'Tivd �r / iTil S� �va�.?t' /`1�o?aC 3�� /�i3 <br /> Ownei 1da�hny AAdress Ci1y 7�n Phone <br /> S� �O. l7•� / f�_F!/r.P<�_S�.�oC 3 s i I i�3 <br /> � AppliCant Maling Addr��s Gity Zip Phone <br /> Deser�hc Proposed 1NorM ����� � /b�, ��__��� `-`ui� �,� <br /> g- l�� ��� � �� I.1-15�I'Act1�. -���'L '�U�d-li�C.lc� <br /> �l ��- LI.F-L -�u`� . G�-� �i� �' \ � <br /> W <br /> Pro�er.t AAdress Id known� � <br /> A�tath lom I41 cop�es 0� p�ans loi proposetl work- Draw to SWIe and note thr lollowmg as appliwble � <br /> • Property lines • CeMerline ul sireel � <br /> • Outlme ano tllmensio�s ot all e*rsimq antl • Indicate Norih <br /> proposetl S�rUCWres on Ihe Ioi • Show any p�JpoSed gr�tliny changes <br /> • E.istmg an0 proposed util�ties • Show measurements � <br /> DO NOT WRITF BELOW T111S LINE O <br /> PERMIT GONDITIONS <br /> 1.All call:lor inspection shall be made 24 hrs.in advance-phone 259-8810. � : <br /> 2.All work shall be pertormed in accordance with this permit and current Gity ol Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Call Location Underg�ound Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-SSbb. � <br /> � --��-� �Q-tltzrx- �Ib►-�S cY -tl�L�rl�"'1-� ���\�b O <br /> R� /-�1L��� `��Pu���-tl��-, <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEM[NT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm� <br /> less the Clly ol Everetl Irom any and all claims tor damages, cosls. <br /> �� ezpenses. or causes of aclion that may arise 6ecause of installa�ion <br /> �,,�� " j�� and maintenance ol the improvement or other right-obway use here�o <br /> t� ^ � applieA for and lurlhm agrees to remove same upon no6ce Irom the <br /> //1 prove Iqr�onsl 1bn ' / Date City and to replace public property damaged thereby. <br /> �- �-�� �`���'� ��� <br /> FINAL INSPECTION Dale <br /> Approved as Conslructed i� natwe Ap ant � ate <br /> �„i.��.�� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE SiARTED WITHIN <br /> 180 DAYS OF DATE P[RMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200CedarSireet BE CILIGENTLV PURSUED TO CI�MPLETION. THIS PERMIT MAV BE <br /> Everelt.WA 98201 CANCELL[D BV THE CITY UPON ANV STOPPAGE UF WORK ON TNiS <br /> Phone:259�8810 pRpJECT OV[R 90 DAYS DUF7ATION <br />