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DeIB_=l �- �� ^ r��eer.woksv�.,m��,�_�_ <br /> Annhca'�en For n�aq o�oi . _��1� — -- -- <br /> PUBLIC WORKS PERMIT �°°°;o,w«e���s- — <br /> LP35 P(1(11 �1!P.PT�U S�. <br /> Print or Type Only o,�a� ,.m:, s _ <br /> �r�, F�i < <�n1�;r� �a �r�� ��C� I <br /> Ow�ei MaiMng Atltlress C�ty 7ip Phone <br /> C�.���� ��� ��� �e � l��l«l-� �W 1��� <br /> `p hcant MaiGng AdAreSs Cdy Lp phpne <br /> Descnbe Proposed 1York _ � �/\X :�'.,'!'C I � _ I � �� . <br /> Pro�ect Address lil knownl _ I��` _ � <br /> � <br /> Attach four 14)cop�es ol pians lor proposr.d w�nrk• Draw to scale and note the toliowing as applir.able: � <br /> • Properry Lmes • Centerline ol strect � <br /> • Outline and dimensions ol all ex151mg antl • InAicate Norih <br /> prcposetl slrucWres on the lol • Show any pioposed grad�nc�changes <br /> • E.rstmg and proposod utilAies • Show measuremenls � <br /> 00 NOT WRITE BELOW THIS LINE <br /> PERMIT CO�IDITIONS � <br /> t.All calls lor Inspectio�ahall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work ahall be pedormed in acwrtlance with thic permit end current Ciry ot Everett Design and Construction <br /> Slendards end Specilicstions. <br /> 3.Cell Locetion Undergrou.�tl Service 48 hrs.belore you dig.TOLL FREE NUMBEH 1•800�424•5555. � <br /> ���;� ����� ��-� y� ���/ ��.r�,� O : <br /> ��-zs�-89 ~ : <br /> � <br /> � ' <br /> a <br /> ACKNOW'L.`_DGEN�ENT QF CONDITIONS <br /> The unde�si�ned owner/applicant hereby ayrees to hold and save harm• <br /> less the i��, .A Everett Irom any and all claims lor damages, costs, <br /> expenses ui rauses ol adion Ihat mp.y arise ber,ause of installatinn <br /> and mamt�nan.e ot Ihe inprr,�emenl or other righFof�way use hereto <br /> applied ior anA lurthei agrecs lo remove same upon notice from the <br /> Approved for Construction Date City and W �eplace public pro�erty damaged �hereby. <br /> FINAL INSFECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> WORti AUTHORIZED BY THIS PERMIT MUST BE STAHTED WITHIN <br /> everetl PUBLIC WORKS DEPAR7MENT 190 DAYS OF DATE PERMIT IS ISSUED AND THE(iEAFTER IS TO <br /> � 3200 Cetlar Street 8E 61LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�OB10 PROJE;T OVER 90 DAYS DURATION. <br />