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PUBLIC WORKS PERMIT ��e_I Z q� � <br /> � PUOIIC WORKS DEP�T�IENT <br /> RibNc VPorb PenrNt• <br /> 3200 Cedar SUeel <br /> Everott.WA BB201 259-8810 BWdkq PermN« <br /> TYPE OR PRINT ONLY pudk Work.Fee t ?.�� <br /> T�aw. c T, n '7: � ^ P ) �pX ZSEUche �, �I/n �1��6�25 �/2s'2S''�� <br /> °w"°' "'g ndd�a cnr na Pna» <br /> C�����Zo�.�►+4�—�2 J 1 5"rM,� fl, L9,� �ut r� T/,� � cv SS� <br /> napxeont �ung�od.�a cav aa an«�e � <br /> Describe Proposed Work c �, ►C W� � <br /> �e G PS �o o� curd. - x � <br /> � <br /> PROJECT ADDRESS(if known) S l � <br /> Atlaeh four(4)copbs of plans tor proposed work•Drew to scale and note the folbwin H � <br /> 9 ePPlfcable: <br /> �Property LJnes `Outlina and dimensions ot all existing end qoposed shuctures on the bt 'Existing and propo�ed ut�lkias O <br /> `CentMine of street •Indicate North 'Show any propoeeU grading changas �Show measu�prnentq � <br /> DO NOT WRITE EIELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be performed in accordance with this pertnk and ci:rtent Ciry�of Everett Des{g�and <br /> Constructlon Standards and Specifications. � <br /> 3. Call Locaiion Underground Service 48 hrs. befora you dig. TOLL FpEE NUMBER 7-800-424-b666,f � I <br /> V� � <br /> �f. L�xvt� �nc� �o.s�s on 5�;tt� �we.. Q <br /> a-� l�,st 4 � �rst of c;� c�.ta�-;�a,yi::. . a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> , 7 The undersigned ownaNapplicant hereby aprsea to hold and save hrmisex <br /> (i 3 g the Ciry of Everett from any and all Gaims for demapas,coste,expansss,w <br /> App vetl or nstru ti Date causes ot actbn that mey erise because ot installalion end maintenrice ot <br /> �� the impro�+emaN a other ripM-of-way uee I�eto applietl far and hrctherapraey <br /> � 10 rem �oNce hom the CNy and ro ra{Nace pubNc pmperty <br /> /�' ' ur" q �' e�°' <br /> INSPECTION Date �— <br /> Mqoved es Constnicted G <br /> " �� t <br /> Sign W/WW' Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED WI7HIN 180 DAYS OF DA7E PERMR IS ISSUED AND THERFAFTER IS TO BE DIIJOENTI.V PURSUED TO <br /> COMPLFiION.�}11S PERMIT MAY BE Cn�'�CELLED BY THE CI1V UPON ANY STOPPAGE OF WORK ON THIS PROJECT pVER 90 DAYS DUFiATpN, <br />