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, <br /> LDate� G ' —` ' r„oi��wo,ksae,mn. _ _ _ _ .. <br /> Applicaiion FOr ��en O�n� • . <br /> PUBLIC VVORKS PERMIT ���:��� w��,=��� --- <br /> ,�,�,���a s <br /> �es.aoo�reavn�n S <br /> x�"~�1 PrintorTypeOnly �.��a�«o�P 5____ <br /> t+7 <br /> aH <br /> ��H <br /> �y " •�.� �' �U' "� _, �� �, 9h <br /> �?'�V� UT��� n. �%[�n[ .__ ct_- -i('-��;�z�✓ :. c.� '+.�.�� .�5. �-, . <br /> y y� OwnCr � MaJing Atltlress Gly Zip Phone <br /> t! C'] <br /> O 50 �)�a,-.�c, <br /> 'i1 NH Applicant MailingAtldress City Lp Phone <br /> yzr /, , <br /> � Qy� Describe Proposed Work ������ � 2�<Lt�o��� <br /> � H <br /> � �8 <br /> �i]V [] <br /> W ' <br /> z r-i <br /> � yx � <br /> H y Pro�ecl Adtlress(il known� .'��<-'4, '-ji'.���'r �±L�f d <br /> y � f <br /> �"� Attach tour 14)copies of plans lor proposed work-Draw to scale and note ihe Ioilowing as apolicable: I <br /> C'7 C7 tn � <br /> C • Pronerty Lines • Centerline ol streel � <br /> tl�� • Ou�line and dimensions ol all existmg antl • Indicate North <br /> z y N proposed sVucW res on t�a lot <br /> H O ti • Fxistin • Show any proposeA 9ratlin9 chanycs , <br /> g and proposeC utilities • Show measurements <br /> DO NO7 WRI7E BELOW THIS LM[ � I <br /> PERMIT CONDITIONS O <br /> 1.All calls lor in�pection shall be made 24 hrs.in ativancc�phone 259•8810. � . <br /> 2 All work shall be pedormed in accordance wiih ihis permil and cunent Cily ol Everett Design and Consiruction ' <br /> Standartls and Speci�ications. <br /> 3.Call Location Undergmund Serv�cc 48 hrs.bebre you diy.TOLL FREE NUMOER 1-$00-424•5555. � <br /> � _ <br /> �� <br /> �t �'� /c���<'c � L-i'�._ ../,) -.�,. � .;� /� � <br /> , , � r _,���<<,�1. <br /> w � ��j",f� ��,. -. %��. . � �, <br /> � ' -,' .. -, ` � . <br /> O <br /> n � a <br /> ,�-� <br /> e � AL'KNOWL[UGEM[NT OF CONDIiIONS <br /> The undersiyned owneqapplicant hcreUy agrees to hold and save harm� <br /> less ihe Cily ol Evere�t Irom any and all claims lor damac�es. costs. <br /> expenses. or causes ol aclion ihat may arise Uecause of installation <br /> ..� � and mainienance of Ihe improvement or olhcr right�obway use he�eto <br /> apP�icd for and lurlher a rees to remove same u on notice ��om thr <br /> ApProved for Cons�ruclion Date 9 P <br /> City and to replace publiC property tlamaged Ihereby. <br /> FINAL INSPECTION Dale <br /> Approved as Consiructed S�e�nalwe ol Applicant Date <br /> evercit PUBLICWORKSDEPARTMENT WORK AUTHORIZ[D BY THIS PERMIT MUST �E STARTED 1NITHIN <br /> � 3200CedarSiraet 180 DAYS OF DATE P[RMIT IS ISSUED AND TH[REAFTER IS TO <br /> [reieu.Wng920t 88 DILIGLNTLV PURSUED TO COMPLETION. THIS PLRMIT A1AY BE <br /> Phone.259�8810 CANC[LLED�Y TH[CITY UPON ANV STOPPAGE OF WORK ON iHIS <br /> PROJECT OV[f7 90 �AYS DURATION. <br />