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Date ���"1�'"�� <br />Applicatlon For <br />PUB! IC WORKS PERMIT <br />Print c.r Type Only <br />"� 3f�/�?� - <br />� _ <br />ADPlicent Meiling A�dresa C��y <br />y, � L `5 L <br />Pum¢ Wodr Pmmn . <br />ninv oeoi • -- -- <br />v�ni�cwnrkePoe 6 OQO• UC� _ <br />ima� Pee <br />Loef AODI vee Pe�e 6 —� <br />fieiimce One a � � � , <br />---- � 6 /Yi <br />?t-� �ZTo2 //�6 <br />Phcne <br />Phone <br />Uescrlbe Propoead Worl: _�L�JS'r�-� � ���L � r��� ��L� <br />— ;:_�,�: � � ,o� s. �- _ <br />Pro�ect Addreae (il known) - <br />AlteCh lou� ;44 cn01e� ol 0����;s �or F:r,F' srd worM - Dreu� to scele end nole Ihe lollowin9 as <br />• F'ioperty I Ire.e <br />•Outline. ddlme�����n� cl•"r:�sting.- <br />proposeil slructuree on thN lot <br />• Exlstinp und proposed utilibes <br />• Cenlerline of strr.et <br />• Indir.nte North <br />• Show eny p�oPosed -•^�'in0 changes <br />• Show meesurumenls <br />PERMIT CONDITIONS <br />1. All cells for Inspectlon ohnll be mede 24 hrs. in ativence - phone 259•88i 5. <br />2. All work ahell be perlormed in eccordencn wlih thie pe�mil end cwrenl Cily ol Everett Design nnd Construction <br />Stendards end Sper.11lcntione. <br />3. Cell Locetlon Uoderground Servlce 4B hrs. h?lore you dig. TQLI FHEE NUMBER 1•800•424•5555. <br />� <br />%� <br />Appr ed lor Co <br />��� <br />Approved ae Conalruclad � <br />ev:•rett PUBLIC WOHKS 0 <br />� 3200 Ceder S�reat <br />Everett. WA 98207 <br />Phone:259�BB15 <br />Date <br />z'�_�_ <br />oai� <br />ACKNOWLEDGf:MEMT OF CQNCITIONS <br />W <br />�' <br />� <br />�w <br />�/ <br />O <br />a <br />Thr �r oarsigned owr��/epp�i�.e.nt he�eby egraes tc, nold and save horm- <br />Irss .�e City ul Evere�l lrum eny a�d ell claims lor dameges. cosls. <br />expenses, nr causes ol aclion Ihet may arise becausa ol ���telletion <br />s.iC meintenonce ol Inq improvement or olher right�o'-way use hereto <br />epP��ed br nnd furthei aBrees to remove seme upon notice Irom Ihe <br />Cily end lo replace p'�blic properly demeged ihere�iy. <br />� � , <br />— c : . < <f i <br />� �f, . ( —� ' �----- <br />'Signetura of ApPlicant Dete <br />80RDAVSTOFORDATED PERMIT ISEISSUED AND THER AFTDq �SHI� <br />BE DILIGENTIY PURSUED TO GOMPLETION. THIS PERMIT MAV B[ <br />CANCELL[D BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAVS DU7AT10�1 <br />