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�BtQ__L PuAhc Work�Permtl� <br /> AppliCa�ion Fof B'0� Dap1 ' � <br /> �' <br /> PUBLIC WORKS PERMIT PUEIicWorksfee — <br /> miai re� s <br /> leea�ooi Fe•Pero S <br /> Print or Type Only e"'"`e°"' s <br /> l a�,�,�,..d (,�� ����_A� I go► 2e.�e.�„ � � 9 y�3 as�-�u,� <br /> Owner Mailing Address Ciry Zip ahone <br /> l�L✓� <br /> Applicant Meiling AOdress City Zip Phone <br /> Describe Proposed Work .�t"� ( 1�Q�1�1�0��� <br /> • ProjeciHdd�eas(ifknown) - B��(.J� � <br /> Attech lour(4) copies o1 piens for proposad work- Draw fo scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions ol ell existirp end • Indicete North <br /> proposad slructures on tha iot • Show any proposed pradfnp changes <br /> • Existing end proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calle for inepection ehall be mede 24 hre.in advence-phone 2b�6810. � <br /> 2.Ail work shsll be peAormed In accordence with thia permit and current Ciry cf Everett Design and Conatrudion <br /> :•tendaMs end Specifications. <br /> � 3.f'all Loc�tlon Underground Service 46 hra before you dig TOLL FREE NUMSER 1-800-4245655. � <br /> ��� ��r►�w� � w�-� (��. � <br /> ���, � _2 � �1( �., <br /> � <br /> �k � <br /> ��b�e � y��5�. o�� ����`�P� a <br /> � <br /> ��� s L,.���`vd�`�,�,dd��£iw�-- <br /> L .� ACKNpW�EDGEMENT OF CONDITIONS <br /> �t,/ r`.c" � <br /> The undersigned owner/applicant hereby agrees to hold and�ave harm� <br /> less ihe City of Everett from any and all cl,�ims for dama�ies, costs. <br /> expenses, or causes of action that may aris�� becausr. of iiistallation <br /> and maintenence of the improvement or other right-of-way��se hereto <br /> appiied for and turther agrees to emove sam= uaon notice from Ihe <br /> Approved for Construction Date City and to replace pu ' �damaged thereby. <br /> / ,�/ <br /> FINAL INSPECTION Date � " � � <br /> Approved as Constructed Signature o1 licant Dete <br /> � PUBLIC WORKS DEPARTMENT WORK AU ORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CadarSheet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet4 WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:25&8870 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WOHK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />