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9 <br /> V <br /> Date_��-�.�'"c5 ( �,,�., w,,,�.�,,.,� �y%y� `T <br /> APUIiC:thOn Fn' Bin�i Deo� . �_�,�`"��9 <br /> PPJF:.IC WORKS PERMlT ��°���°,°°���«� ------ - <br /> ,o�,��P� s- — <br /> iess anm rer rain 5 <br /> ��T__ <br /> Print or Tyoe Only �,����o�� s_ �—_.__ <br /> ��G�.�r�r �l�-(� . q�� ��5�aaa <br /> wnei Mad�ny Atldress City Zip Phone <br /> `���b _ _ <br /> Apphwnt Madm9 Address City Zip Phone <br /> Describc Proposed\Nork l�� �� _— ��� �— <br /> A il l..l�{—� / <br /> Pro�ect Addressld kaownl /��� - �/��`�����F � <br /> � <br /> A�12Ch lour 141 copie5 0� PIOns for propo5�•A work� Draw to scale and wte Ihe toiiowmg as apUlic�ble � <br /> • P�operty L��es • Centerline ol streel � <br /> • Outl�ne anC dlmensmns ol all eushng and • Inaicate Norlh <br /> proposetl struclures onthalot • Ehow any pronosed giaam9 chanyes <br /> • Enistmg and proposetl utlhties • Show measurements � <br /> 0(? NOT WRITE �[LOW THIS LINE O <br /> PERMIT CONDITiON3 <br /> 1.All calls lor inspec6 on shall be made 24 hrs.in adv�nce-phone 259•88�0. � <br /> 2 All work shall be peAormed in accordaoce with ihis permil and wrrenl Ciry ol Everett Design and Construction <br /> Standards and Spocifica;ions. <br /> 3.Call Location Unduroremd Service 48 hrs.betore you dig.TOLt FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGFMENT OF CGNDITIONS <br /> �hc undr 9ned owner/appllcant hereby agrees to hotA and save harm� <br /> — — Iess Ih� - o� [vereit irom any and all claims lor damages. costs, <br /> � � � expen� � csuses ol action that may arise because ol installation <br /> � �`� L � C / and m � .nce ol �he noFrovement or other rlgh��ol�way use hereto <br /> � applie end lurlher ac�rees to remove same upo� noGc� Irom the <br /> AFP�o�ed lor Cons��uction � � Date City a - ' replece public property damaged thereby. <br /> / ���(.��� ^� � <br /> ..�=� ��->�o . �) c z <br /> RNAL INSPECTION Dalc <br /> ApP�oved as Gonstructed �-� - ure ol App ant. � Date <br /> RK AUTHOIiiZED BY THIS PERMIT MUST BE STARIED WITHIN <br /> evrrett PUBLIC WORKS OEFARTMENT 1B0 DAYS OP DATE PERMIT IS ISSUED AND THERE�FTER IS TO <br /> � 3200 Cetlar Streel BE DILIGPNTLY PURSU[D TO COMPLETION. THIS FERMIT MAY BE <br /> Everett.WA 99201 C1INCELIHD BV THE CITY UPON ANY STOPPAGE OF WOI7K ON THIS <br /> Phcne:259�36t0 FROJECT O\'[R 90 DAYS DURATION. <br />