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� /7� �i] -� <br /> Date_L-+2Lt1-J ( �„ni..w�„w.i�..,m,i. /�� <br /> APPIiCalwn Fo� Iaina o�.ni . �} ��cl�,�� _ . <br /> —�-l-�_'_ ___ <br /> PUBLIC WORKS PERMIT F������w���=��.� ----- <br /> ,��a�«� s <br /> �«,sA�„� �.��«�� s <br /> Print or Type Only o,�a���o�� s <br /> �1'�'a►-� � 1 �i�-�� �=�Fl�� ��i� �t-iY���� � rr�l- q�,� � �-q i� <br /> Ownei Madmy Adtlress C�ty Zin Phone <br /> �i����-cr <'nrl��t-C'F �=x� ���x ��y� v�r� �i� �r� z�- ►► 3� <br /> Applicant Mailing Address Ci1y 2ip PhOne <br /> Descnbc Proposed Work �� � ��1_� <br /> W <br /> Project Address�if knownl � <br /> AUach lour l41 copies ol plans lor proposed work� Draw to scale antl nole the lollowiaq as apUficable�. � <br /> • Properry Lines • Centerline ol streel � <br /> • Outline and dimensions ol all ezistmg and • Indica�e North <br /> proposetl structures on ihe lot • Show any pwposed gratling changes <br /> • Exishng and proposetl utiGties • Show measurements � <br /> DO NOT WRITF BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cells for inspection shell be made 24 hrs.in ativance-phone 259•8810. � <br /> 2.All wo�k ghall be peAormed in accordance wilh this permit and current City ot Everett Design and Constructfon <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � � � , � � <br /> � �- � - �..� ���� O <br /> / - 2v'-�9Y <br /> � `; <br /> � � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thc undersigneU owneqappliCan�hereby agrees t0 hold and 5ave harm• <br /> iess the Ctly d [veretl Irom any and all claims lor damages, costs. <br /> eapenses. or causes ol action �hat may arise because ol installation <br /> and malntenance of the improvement or other right-o4way use hereto <br /> apPlied for and furiher a�rees to remove same upon notice Irqm the <br /> Approved for Construction �����' City and to replaCe pu6lic prope�.ry damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signa�we of Apphcant Date <br /> everett PUBLIC WORNS DEPAR7IAENT WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA gB201 BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Fhone�259�BB10 GANCELLED BY 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � PROJECT OVER 90 DAVS DURATION, <br />