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h <br /> Date_ - ' � <br /> vunuc wo�wsrnima. <br /> ApplicAtion for emQ oeoi • .—��_ <br /> PUBLIC WORKS PERMIT P��Te„F�s�•�-s_--- <br /> �eee enn� raa���n S <br /> Print or Type Only Bw�.��•o,�• s <br /> . � <br /> �� +, � �� i�^n�� .S� ti �'��l���r�,l� ��' <br /> �'^'^e Mailing Address City d ip Phone <br /> i�(< Y' J�Vl`�1��� �I/� �l�,t'Yll(Ya l�1�8C����— <br /> �p6cent Meiling Address City �^ Zip � phooe <br /> Describa P�oposetl Wcrk (� . <br /> Prolect Addrees�I�known) � � <br /> Allach lour 14�copies ol plens 1�;proposed work- Draw lo scale and note Ihe�ollowing es npP��cable� � <br /> • Property Lines • Centerline oi strea� � <br /> • Outline and dimensiona ol all existing end • Indicate Norih <br /> proposetl strudures on ihe lo� • Show any proposed greding changes <br /> • ::xisting end proposed ulllitles • Show measuremenis � <br /> DO NOT WqITE BELOW THIS LINE <br /> PEHMIT CONDITIONS O <br /> 1. All cells for inspection shell be mede 24 hrs. In advance• phone '259•88�$. � <br /> 2. All work shall be parlormed in eccordance wifh thla peimil and currenf City of Everett Design and Construclion <br /> Slentlerds and Specifica�ions. <br /> 3. Call Loce�ion Undarground Sarvice 48 hrs. belore you diq. TOLL FREE NUMBER 1•800•424•55b5. � <br /> �U/jL- /�. �!-��J�'�C� f�n%1�/T N�i ' i cJ ��r O <br /> � i( C CjC✓.c.%/) //�/ <br /> � � � � <br /> O <br /> a <br /> ACKNOWL�DGEMENT OF CONDITIONS <br /> Tht dndersigned owner/appliceM hereby egrees lo hold end seve harm� <br /> less Ihe Cily ol Evrrell Irom any and all cleims lor demages. cosls, <br /> expenses, ar cauaet o� ncfion Ihat may erise beceuse ol Installntion <br /> end maintenance ol Ihe improvemeN or o�hr.r nghl�of�wey use herelo <br /> epplied for nnd fwiher a rees to �emove same u on nMice Irom Ihe <br /> Approvqd lor Cone�rUCtiOn Date City and fo rePlace n�6licyprope�ty damaged Ihereby <br /> FINA� INSPECTION Dale <br /> Approved as Construcled Si9natwe ol Applicant p��e <br /> PVPlPt� PUBLIC WCRKS DEPARTMENT WORK Al1THORIZED BV THIS PERMIT Ml1ST BF STARTED WI fHIN <br /> � 32�0 Cedar Sireet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS 70 <br /> Eva�ett.WA 98201 BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone� 259-8815 CANCELLEO BY TH[ CITV UPON ANV STOPPAGE OF WORK ON TNIS <br /> PROJECT OV[R 90 DAYS DURATION <br />