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� .�� <br /> , <br /> � <br /> � <br /> i <br /> � <br /> ;; <br /> �/�y;� �� , i <br /> Date_ICXc�II P„e���wo,�,ad,m��. '� -�'c'�� <br /> AUPlicalion For A�`�0 °ip1s ��'C=J---- <br /> � — _— �. <br /> PUBLIC VI/ORKS PERMIT r�^���W�,�s��� ------ ' ' �`' <br /> .o�.,�v�„ S_ _ ; . <br /> Less Anol Fqo Pnia 5 � � <br /> 1 C:_�_ <br /> Print or Type Only oa�a��,�o��� s ��' — _ j <br /> �� ���. � i,r f`� �C�a��1�s �y�r� tic�� � � ��a �- �� � . ��z� <br /> Owner MaiNng Adtlress Ciiy � 7ip Phone - <br /> ���9I1'�� <br /> Applicant f.tailin9 Address C�ty Zip Phone I . _Y�� <br /> ,` �i /'� /� .-.//� 1 ^,� I <br /> � Describe Proposed Work ��AJ , �'�� _ (_A'J� r�C ..f'r�,�/i[ / ,�( � ,�,1 )� ; <br /> Prolect Address lif known) 7 / Q�) — �}h A✓E. W, � <br /> Atlach lour(4) copics ol plans for proposed wo��� Diav, ,o scale and note the follo�,oing 8s applicable: � <br /> • Property Lines • Centerline o: street � � <br /> • Outline and dimensions ol all ezisting and • Indicate No�th <br /> proposed sirucWres on the lol • Show any proposed gradinc�chanyes <br /> • Exis�ing and proposed utilities • Shov; rt,easurements � . <br /> �O NOf WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shali be made 24 hrs.in advance-phone 259-881 O. � <br /> 2.All work shall be performed in accordance wi,h this permit and current City of Everett Design and Construction <br /> Standards and Speci(icalions. � <br /> 3.Call Location Under9round Service 48 hrs.belore/ou dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> O <br /> �w � <br /> �/ ! <br /> O <br /> a <br /> ,`��\'q ACKhOWLGDGEMENTOFCONDITIONS <br /> r1 ''J The undersigned ownedapplicant hereby agrees to hold and save harm- � <br /> less the City of Fverett Irom any and all claims for damages, cosls, <br /> � expenses, or causes of action �hat may arise because of installation <br /> / , f� . /;-__ / ��.�� and maintenance ol the nnprovement or other right�ohway use hereto <br /> , � "/ '"y�� r applied for and further agrees to remove same upon notice (rom the <br /> Approved for Cons�rudion Dale City and to re{.:�ce pubhc property dama9ed �hereby. <br /> .��..yG� ,F -�- �-� �/ r--� � <br /> FINAL INSP TION Date t�-/--, � �"-- �/Z 7 /V 7 <br /> Approved as Constructed Si)r�iur�Applicant Date <br /> everelt PUBLICW01?KSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO '�, <br /> Everelt,lh'A913201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8tl10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TFiIS <br /> PROJECT OVER 90 DAYS DURATION. <br />