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� � Put�.xr Woas{'crmn• � ` -- <br /> Date� eiau n»m • —' <br /> Application For <br /> PUBLIC WORKS PERMIT °"°"`"'°'",`°` <br /> tr.�l Fee s <br /> Lesf�pDl ie�Pxi� s <br /> Bnimcn Oi�a s <br /> Print or Type Only <br /> � �-. � �-I I �u-�� � ir��� �- � c�, �� �r-���4 ��� <br /> Owner MaiGng Address <br /> � CiIY 2iP P ione <br /> i�''.�7C7E!(�� �1"lS�.�1��'l�YY1!`t�. --� I� --��¢�j����'�3 3�'s' Q7�1 <br /> � ����__(� c'N Phor.. <br /> AUP�i�a�� Meiling Ai'dress ��Y <br /> Doscriba Propoaed Wo�k <br /> . ��JS�C�—�`-�n�`�"" ��____.___— —_ <br /> _ _ --- — — W <br /> � <' C�� . -/') �`'S — � <br /> Proieu Address hl knownl �_ <br /> Attach lo�r(4)coples of plam lor preposed wo�C- Drew to scale end note the following es eppiicnhle�. � <br /> • P�operry Lines • Canterline ol slraet <br /> • Indicate North <br /> � Outline end dimensions ol ell exis�ing and � Show any proposed greding changus <br /> proposed structures on th�i lot � ghow meesurements M <br /> • Existing end proposed utilities W <br /> DO NOi WRITE BELOW TMIS LINE O <br /> PERMIT CONPITIONS � <br /> 1. All cells Im insPection ehall be made 24 hrs, in advance�phone 259•8e�5. <br /> 2. All work shall be parfom�ed In eccordence with this permit and currenl City of Everetl Design and ConsVuction <br /> Standarda end Specificetlons. � <br /> � 3. Cell Locetion Underground Servlce 48 hrs.b��d� T�L FREE N���p i;��4f 4•55 . ' <br /> ��I� �,C�R'`..� 11 �C � i,U L i �b/e O <br /> . �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicen�heraby egrees to hold and sava harm- <br /> — less the Cily of Everett fmm eny end ell cleims for demeges, costs, <br /> expenses, or ceusss of acliori tha� may erise because ol Inste�la�ion <br /> appliedllo� enA furihe Qegre sVto Bemove'sameu Pton'no�ceg�rOmrlhe <br /> ---- Dete CiIY end lo replace public property demaged thereby <br /> Approved lor Construc�ion <br /> FINAL INSPECTION Dale Da�e <br /> Signelure of APplicant <br /> qpprovedasConstructed WORK AUTHORI2ED BV THIS PERMIT MUSi BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTNiENT 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTEf' IS TO <br /> � 3200 Ceder Streel BE DILIGENTLV PUHSUED TO COMPLETION. THIS PERMIT MAY BF <br /> Everetl.WA 98201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON TNIS <br /> Phone�. 259�8815 PROJECT OVER 90 DAYS DURATION. <br />