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oate-� JdQ �,��,�,�w�,,..��,m��p.p, l <br /> �/ � u�na o�n� • —o-/-�—��ZO:_-__. <br /> APPI�raiio�l FO� <br /> PUBLIC WORKS PERMIT `'��';o,.���`'° __ — - --- <br /> ioss nno�tnr re�n S <br /> ori+��„n�� S <br /> Prinl or Type Only <br /> ��,'�-� �r��n c.l 3G'2G Y�,r l�n 1�3D4 F �'vei e� ��11�/ �S9_2�l.�2 <br /> Owne� Madmg AAtlress Gly � Phone <br /> �r�l <br /> Apphcant Ma�Lng Add�ess Cdy Zip Phone <br /> Descr�be ProCosed 1h'ork �P1((�N� /Mjt�f�(JP�-�L� �f�4�P�n"� s���� A�""�D� <br /> - W <br /> Prolect Address dt knownl . � , <br /> Attach lour�4)cop�es of pians�or proDosed worM� Draw to swle anA nolr, the tollowing as applicable: � i <br /> • Property Lines • Cen�erlme ol street � ; <br /> • Outhne and dimensions ot all eK�sting and • Ind�tale No��h <br /> proposeA struclures on the lot • Show any proposed gratling changes <br /> • ExisUng anA proposed utihties • Show measurements M <br /> W <br /> DO NOT WRITE BEIOW THIS IINE O <br /> PERMIT CONDITIONS � <br /> i.All calls lor inspection ehall be mede 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be pedormed in accordance with ihis permit and curreM Ciry of Everetl Design and Const�uction <br /> Standards end Specifications. � <br /> 3.Call lxation Underground Service 48 hrs.belore you dig.TOLI FREE NUMBER 1•800-424•5555. <br /> O <br /> �7 7 <br /> ILD f �=��.�tit� k-C=,-�'�. � <br /> ��� % �,-t ` �-�� N <br /> �� - i �-���j 0 <br /> a <br /> ACKNOWLEDG[tAENT OF CONDITIONS <br /> The undersigned ownedapP�iranl hereby ag�ees to hold and save harm- <br /> — less the Gty ol Everetl trom any and all claims (or Aamages, costs. <br /> exnenses, or causes ol action that may a!ise because ol installation <br /> and maintenance of Ihe improvement or other righFobway use herelo <br /> apphed lor and lurlher agrees to remo��e same upo� notice Irom the <br /> Approved br Conslruction Date Ciry and to replace public property damaged ihereuy. <br /> FINAL INSPECTION Date Dale <br /> Approved as Construcled Signalure ol Applicant <br /> �VORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBI.ICWORKSDEPARTMENT 180 DAYS OF DAiE P[RMIT iS ISSUED AND THE9EAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.259�8810 PROJECT OVER 90 DAYS DUR4TION. <br />