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�ate—!_J��� !" '�� �„�,��< Y,,,...���, //� - - <br /> Applicatien f o� �3�"" o'n� . �/�-r-."-�'�"'. <br /> PUBLIC WORKS PERMIT �°°;�,:���p���s --- — <br /> �«ss nnn� r.�vn�a S_ <br /> Print orType Only e.�a���o�� s <br /> �.�.� �P � �At-1t�2�T" ��b�" �5�--7� <br /> Owner � Madmg AAnress Clty Lp Fhone <br /> �' r� �Ki "� �17��-��.�i�N- ���03 �5�a ��� <br /> qpphc 1 Ma�hng Atldrrss Gty Lp Phone <br /> Describe Proposed Wark C�` 9'�FTCL"TL.`����71,1���` I"��� _ <br /> �J <br /> Pro�ectACtlresslitknown) �� ��e.Gl1--r�,.�.d�� — � <br /> � <br /> ABach lour�4�cop�es of plans lo�proposed worM- Draw lo:cale and note Ihe lollowing as applicable: � <br /> • Property Unes • CenterGne of street � <br /> • Outline and Aimensions ot all exishng and • Indicate North <br /> proposeA structures on Ihe Iot • Show any proposed gratling changes <br /> • Ex�shng and pr000sed ulihties • Show measurements � <br /> DO NOT WRII E BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inapection shall be made 24 hrs.in advance�phone 259�8810. � <br /> 2.All work shell be pertormed in accordance with this perm'1 and current City of Everett Design end Construction <br /> Stantlerde and SD�ilications. <br /> 3.Call Location Underground Service 4B hrs.befo�e you dig.TOLL FHEE NUMBER 1•800-424•SSSS. � <br /> �CQ��C/ Gt/Ch/�f`"�✓�ru/ /(/�y> .�CG�yL^Luty •^ 7�B'B/ O <br /> � ��:���� H <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undeisipned ownedappllcant hereby agrees to hold and save harm- <br /> -- Iess the Cdy of Everetf hom any and all claims for damages, cosis. <br /> expenses. or causes of action that may arise because of inslallation <br /> and maintenance ol the improvement or other right-of�way use hereto <br /> _ applied �or and lurther agrees to remove same upon notice from ihe <br /> Appio�ed for Constructic�i Date C1ty and to replace public pwperty damaged ihereby. <br /> F:NAL INSPECTION Dafe _- <br /> Appro�ed as Constructed Signatme r,i Applicant Date <br /> WORK (�UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> eve+ett PUBLICWORKSDEPARTMEN7 180 UAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street pE DILIGENTLV PURSUED TO COMPLE?ION. THIS PERMIT MAV 8E <br /> Everett,WA 96201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF W09K ON THIS <br /> Phone:259�B810 PROJEC'OV[R 90 DAVS DURATION. <br />