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. ._, - <br /> Date�.�.'_9�.f q � �„���.��,�•,,���,�,�. J - — <br /> „��.� u,.�� . _ ��J- L3d� `� <br /> AppLcaUnn I'w <br /> PUBLIC WORKS PERMIT �°°�����,'�°��°°°° - <br /> ,,,�.,���� 5--- <br /> ��..�,,,� �.,.�..,,� s — <br /> �,, , . �• . s <br /> Print or Type Oni�� — <br /> F�✓n��_��a�{,,5� t ��11�c,.���i 1�✓�'rrl� �l�'�c � �75 9-0�93 <br /> Owne� Mndmg Addicss G�Y 7.ip Phonc <br /> X L"0 —_ <br /> Applicant Maihng AdAre;s C�ty Zip Phone <br /> Desaibt Proposed Work — <br /> W <br /> Prolect Adtlress UI Fnown) —�' '��—r--�-c-�+�+�s� � <br /> Attach four 14)copies o' olans lor proposed wo�k� Draw to sr.ale and note the followmg as apphcable�. � <br /> • Property Lmes • Cr.nlerline ol sireel � <br /> • Outline and dimenslons ol all ezisting antl • Indicate North <br /> proposetl s�rucWres on Ihe lot • Show any proposeA g�nd�ng change5 <br /> • Exishng and propo5ed utddies • Show measuremeiAs � <br /> UO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls(or�nspeciion shall be made 24 hrs.in advance� phone 2S9•88�0. � <br /> 2.All work shall be peAormed in accordance wilh ihis permil and curreN City ol Everett Design and Construction <br /> Standa•ds and Specifications. <br /> 3.Gall Location Underground S��rvice J8 hrs.before you diy.TOLL FREE NUMBER 1-ijG7-424•5555. � <br /> 1� � � �1 O <br /> l,�l' � l-l�ll. �"� �.r ��'li , �Lll <br /> � <br /> �I��L 11�1����� � <br /> < <, - Z -�' `( 0 <br /> _-- a <br /> ACIiNOWLEDGGM[NT OF CONDITIONS <br /> The undersiyned owncr/applicanl heieUy agrees to hold and save harm- <br /> — ----- -- iess Ihe Cily o� Everell trom any and all claims lor damages, cos�s, <br /> Ir�xpenses. or causes of action ihat may arise because ol installation <br /> and mamle��ance of Ihe improvemen� or other righbot-way use herein <br /> ❑ppLed foi nnd fwiher �a9��es to remove same upon notice Irom Ihe <br /> Approved lor ConsirUG�ion ���P Cdy and io iepince n�����c piooeity tlamaged thereby. <br /> FINAL INSPECTION Dale -- — <br /> ApprOved as ConS�ruc�ed 5��)nalwe of�pphcanl Data <br /> WORK �UTIiORIZ[D BY TNIS PEFlMIT MU�T BE START[D WITHIN <br /> everen PUBLICWORKSDEPARTMENT 1g0 �AYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Gedar Street p� DIUG[NTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Eveietl WA 90201 CA1JC[LL[� �V TFiE CITY UPON ANY STOPPAGE OF W017K ON THIS <br /> Phone:259�8810 Pf70JLCT OVGR 90 DAYS DURATION. <br />