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_ ✓ <br /> " /�9 <br /> Oate�� �•„5„�wo.�.P�,m,�. � <br /> ApPlicalien For ���o o�m • � ��-- <br /> �UBUC WORKS PERMIT �°°,oW�;.;.'P° : - <br /> lessnnni �eeva�o f — <br /> 9 pC <br /> pairncrpoe S �n'—� <br /> Print or Type O�ly <br /> �'4D„D�.�n�r f 7d����".M,l�ul ,�/�- �un�nf,F- 9R zo3 3SS- �3l�').__ <br /> nei� Mading AAtlress Cdy !ip Phone <br /> SnMP <br /> Apolicant �dndmg Address Cdy Zip Phone <br /> Descn6i� ProposedWork ��/�X _ L.�' � �l ��!-tl��� ���NA/.1 J� <br /> - W <br /> Pro�ect Address lil knownl 5�3 a S��w� "'v ~ <br /> Mtach tom(4) .:.pies ol plans for proposed wo�k- Draw to scale anA nole the lollowing as apP�icable: � <br /> • P��perty Lines • Ceme�line ol street � <br /> • Outllne and dimensions ol all ealsting antl • Indicate Norih <br /> proDosetl siructures on Ihe lol • Show any proposeC grading changes <br /> • ERisUng end proposed utilities • Show measuremeNs M <br /> W <br /> DO NOT WRITE BELOW THIS LINF. O <br /> PERMIT CONDITIONS <br /> 1.All cslls lor inspection shall be made 24 hrs.in advance�phone 25�881�. � <br /> 2.All work shall be performed in accordance with Nis permit and current City ot Everett Design and Conatruction <br /> Stendards and Specitications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE IVUMBER 7•800�4Z4•rJ�Sb�S. � <br /> O <br /> � <br /> � <br /> � <br /> a <br /> � . ACKNOWLEDGEMENT JF CONL�TIONS <br /> � 7he undersigned owner/appP nN hereby agrees to hold anA save harm• <br /> less the City ot Everett In � ,ny and all claims for damages. cosis, <br /> eepenses, or causes ol a�'o� ihat may arise because o� instaltation <br /> ,�'J �1 and maintenance ol Ihe ir ,�.rv,�ment or other right-ol-way use hereto <br /> .�-'- /�)C'�t'->�=— �— 7—�� applied 1or and Wrther ar;��as to remove same apon notice irom 1he <br /> Approved lor Cortr ti n Dale Ci1y and to replace public � operty damaged thereby. <br /> _J%a�,d�C?G�.. /�—rri�i" �Fv .�( r�' ..�A� % � n <br /> FINAL INSPECTION pate �� L -� /' ,' %/7/XL_ <br /> Approved as Consiructed Signature of Applicant Da <br /> WORK AUTHOHIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPAFTMENT 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlerSlreet DE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELlEO F3Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> phone:259�BB10 PROJECT OVER 90 DAYS DURATION. <br />