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r <br /> 7 1 ' 1 :' :f:i ��,E, -� <br /> Date _ - � r�o��w�„5 N��m��. <br /> Applir,ntion For unw neo� � -- � <br /> PUBLIC WORKS PERMIT �°°;oW�Faa�eB s � � — <br /> Less�oo� FeePaid S <br /> Print or 7ype Only e,�e�=wo�a S -- ` ' — � � <br /> i <br /> , i. <br /> i i <br /> �—.� ��:� ��� —�� r �� i. , ; �' � � �, �, �`� �,��, ��. �/��, ��_�� � . �,�� �`��-�- <br /> Owne, Mailing AAd�ess Gry Zip ' Phone <br /> i <br /> r` � � ��'I �i l Jt � lE '%:/ <br /> _�•'i r • t .� � ,�����.'iU/��'� _!_.1.��1� � (<( �I�. � �.'. t��- , 7�. � � !C( <br /> Applicant Mading Address City ZIp Phone <br /> � � . <br /> � " � � <br /> Describe Propoaed Work _�y.-' �� � � �—� ���( ( �1� �� �L� � �i 11��� � <br /> Project Add�ess�il know ! _�v � � � �7 / �" " � <br /> � <br /> Atlach tour(4)cop��s ol plans lor propo5�3d work• Drav: lo scale and nole Ihe lollowing as applicahle. � <br /> • Property Lines • Centr.rline ol sVeet � <br /> • Outline and dimensions ol all�.isting and • Indicate North <br /> p�oposeA slrucluros on the lol • Show any proposed 9rading changes <br /> • Existing and proposed utilities • Show measurementc /� <br /> W <br /> DO NOT''�JHITE BELObV THIS LWE O <br /> PLFId1T CONDITIONS <br /> 1. All calls for inspectinn shall bc made 24 hrs in advance� phcne 259-881 5. � <br /> 2. All work�hall be perlormed in 2ccordanco wilh Ihis permlt nnd current City of Everetl Design and Const�uction <br /> SlandarAs and Specilications. <br /> 3. Call Location Underground Servicr.4B hrs. belure you dip TOI.L FREE NUMBER 1•800•424-5555. � <br /> � fe'e�r �� �Y. � rrs�-�� t�cn <<.� l�1 '�tn � h� ��r•� �iausl- �' e O <br /> c-i: �ti '::. �'�-.,. ._ � �.u.-� t�.. .. Li '�" C- � c: �\ ��,�� <br /> � �� c.�� �.Fl ��ds�- �� ��� -�K_ ,.,._ :� l 1 -�..' ��� V L �, l� � <br /> � �ri � / / O <br /> •' � ��/ /t4a�L i3 /�i'l`.-I�� ral / ��?' �.f f�/�( (' !�i P��'..Y� rC�. 1�'l� a�,� � <br /> r <br /> �-� � / '� �9�� :�,;.. a «, ,� ,r �,., r._J� �. � <br /> -f- � `' `� �' <br /> I � r" l� �� � ,J /L � ` LI � ACI�NOWLED E ENTOFCONLITIONS` <br /> The urde�gned ownei/anplican�hereby agre�.;to hold and save harm� <br /> less thu Cily ol Everett irom any and all claims for damagas, costs. <br /> `�— � � � � e.penses, or causes ol action that may arise because ol inslallTtion <br /> � �7� _�� and maintenence ol ihe improvement or other righFof�way use hereto <br /> �—A�'' � �����L—� applied lof_�nd further agrees lo remove sama upon notice irom Ihe <br /> AppfOved o� r Cons�hon . . Dale City ana tu rdpiace Uublic properq•dam.ged ihereby. <br /> / ' <br /> �l.w��t✓ll� ��"lc�'- ���'� � � � � / � - ) - <br /> NAL WFl SPECTION — —____ _._- Daie '�.:..��"�-�_"- � , .i .� "/j:�, <br /> Approved as Conslrucled SiynaturF�:I AnPiicant �� Date <br /> ���rrrtt PUBLIC WORKS DEPARTMENT WOflK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIiHIN <br /> A20D Cedar Slreel 180 Dl�YS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br /> � L" , , W^ ��?� pF pILIGENTLY PURSUED TO COMPLETION. THIS PF.RMI7' MAY Bt <br /> p y��� CANC�I L[D �V TNE CITV UPON ANY STOPPAGE OF WOFlK ON THIS <br /> _ � � PROJLCT (IVFH B� U�YS DURATION. <br /> L J <br /> ! <br />