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Date—_Y` ��:,�.���v,�,��.��..,:; -�-� �-- <br /> � -� Ain�� oPn� ._�� �tiL.l? — <br /> qpplicahon Fai <br /> PUBLIC WORKS PERMIT °°°"""°,"„" - -- - <br /> Total fee S <br /> IeSSNpPI fClPT�E 5 <br /> � ,l eaianceouc g _ <br /> �� Print or Type Only <br /> H ��S— vS�3 <br /> �y�' —�—�iN ��Os��L/�Cl �3/S =>�c�-�c<��"vj° C�(� Cl�� l-/�8�i3 _ <br /> N �1 Own�r Maihng Address Cily Z�p Phon� <br /> y N � , <br /> �y� �ru.Ce;� �� � /�-��.�'>��7c 3c �" �no-��- 3�-_�.�_�' <br /> O 'r�0 ,� � Cii iP Phone <br /> � y N qpplicant tdailing A�dress )' <br /> ��Ed /Z O� � G��'/�-e^ric.ci' — <br /> C <br /> Describe ProposCd H'o�k � u � <br /> ��g - - <br /> QY �] � <br /> �y� --�� __ W <br /> H Pro�ect Address lif known) ��/� ��-----��'�/—sl"" -- ~ <br /> y <br /> H � <br /> n�y Altach lour I4)copies ot plans lor pwposed work-Oraw lo scair antl note the lollowing as app�icabie � <br /> � � • Property Lines • Centerline cl stree� <br /> • Oulline and dimensions o�all etii5hng and • Indica�e NOrlh <br /> H pwposetl structures on the lat • Show any proposed 9iad�ny r.hanycs <br /> �� • E.isling and Droposed utilities • Show measurements /M <br /> W <br /> DO NGT WpITE B[lOW THIS LIN[ O <br /> P[RMIT CONDITIONS <br /> �� �.All calls lor inspection shall be oade 24 hrs.in advance-phone 259•8810. � <br /> I 2 All work shall 6e pedormed in accordance wiih this permi�and wrren�Gity o1�verett Design and Construction <br /> C� Standartls and Specilicafions. <br /> 3.Call location Underground Service 4B hrs.belore you diq.TOLL FREE NUMBER�•800•424•5555. � <br /> O <br /> I �.� ���2G�:� Cr�cz� i���.1-� �ioP' /'�� , � <br /> I L�� �� � <br /> ,3 -r 5� -9 / O <br /> ��� a <br /> � � ACKNOANLEOG[MENT O�CONDITIONS <br /> The undersigned owne�/apPhcan�heieby a9rees�o hold and save haim- <br /> less thc City oi Everett Irom any and all claims lo� damayes costs. <br /> - expenses. or causes of action ihat may anse because of inslallation <br /> and maintenance of Ihe impwvemeni or other nyht�oi�way use herelo <br /> applied �o� nnd Iwiher ayrees lo removo s�me upon nnticc �iom ihe <br /> Approved 10�ConSlmcllon Dale Ciry.ind lo replace publ�c propmty da�na9ed Ihe��by <br /> FINALINSPECTION Date -- — Da�e <br /> qpproved as Conslructed Signaturc ol Apphcant <br /> WORK AUTHORIZFU 0'� TNIS PEPM�T MUST BF SiARTE� WITHItJ <br /> everrl� FUBLICWORKSDEPARTMENT 180 DAYS OF DATE P[RtdIT IS ISSUED AND THEREAFfEf7 IS TO <br /> � 3200CetlarSlreet pE DILIG[NiLY PURSU[D TO COMPLETION. THIS P[R'dli IdAY BE <br /> [vere�l,WA 9" 11 CANC[LLED BY TI-I[CITY UPON ANY STOPPAGE OF WOP.K ON THIS <br /> Phone:259-di ) PROJ[GT OVER 90 DAYS DURATION. <br />