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��� <br />p�x <br />Qy H <br />t' y �n <br />H�H <br />�H� <br />�Cy� <br />z <br />��� <br />H(*1Q <br />�r nC <br />�HLTJ <br />z <br />�yH <br />C� Cp7 � <br />�yf�i� <br />HOln <br />� <br />�.� -� <br />Date� <br />Applicahen f or <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�1a�lin9 Addre=s <br />Z�n <br />Publ�c \Vpr�3 P�^y��] /7 <br />BIh9 O�.p� • ..y„���«�_ _ <br />� <br />����,<„-o„sF�� <br />,o�.,���e s_ <br />�,•s, a�„� .�. W., �. s _ <br />caianceo��, 5_ <br />Phone <br />App6cant A9ailin9 atltlress City � Z.in Phone <br />DeSCnbe Prpposed Work <br />Pro�ect Address li� /.nownl <br />� <br />AIWch low (4� copies ot plan5 for proposed work � Draw to scole antl no�e �he folle•Ning as applicable'. <br />• Property Lines • Centerhne ol street <br />• Outline and dlmension5 of all ex�sunq antl • Indicale North <br />proposed structures on ihe lot • Show any proposeA grading thanges <br />• Eaisi�n� and proAosetl utilities • Show measuremenis <br />� <br />L�NE <br />P[RMIT CONDITIONS <br />1, All calls for ins�ection shall be made 24 hrs. in advance � pho�,^ 259•8810. <br />2. All work shall be pedormed in accordance with this permit antl cun��i Ciry ol Everelt Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you tlig. TOLL FREE NUM2ER 1•800•424•5555. <br />/ L,i% . l� , i' _ _ ��. ',��/('Y' �..�'I ,� .. , ._ <br />� • S'. <br />7,.. <br />1L�Ct�� �c'CC-'e�- 4L'r l.: ���-�/= - . ��'-:_ <br />� i.� . �C�t�' f � _ <br />�t..t �. c- �'L�.-�{<• <br />Approvetl lor Consfruction <br />Date <br />FINAL INSPEC?ION Date <br />Approved as Constiucted <br />evrrelt PUBLIC WORKS DEPARTMLNT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />Phone:259�8810 <br />�G-.`7>> <br />W <br />F- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACK�OWLEDGEtdENT Of CONDITIONS <br />The undersigr.ed owner/applir,ant heieby agrees to hold and save harm� <br />less Ihe Cily ol Evcrelt irom any and all tlaims br damages, costs, <br />expenses. or causrs o� action that may arise because of mstallaiion <br />and mainlennnce of the improvemeni or other nght-ol�way use herelo <br />apphetl for anA Iwihm agrees lo remove same upon no6ce Irom Ihe <br />Cdy and Io iepiacr public propertY damagetl Iherehy. <br />Siqnalure ol AnDhcan� Date <br />WORK AUTHORIZED BY THIS PEPMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMITIS ISSUED AND THEREAFTEf71S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE QTY UPON ANV >TOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />