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��b� <br />c�� <br />9Hfn <br />H�� <br />/! � <br />� � � <br />V1 H <br />H <br />zO <br />OHd <br />��g <br />� Y (] <br />t" y � <br />Ny <br />8 H <br />C] C V� <br />��[�+ <br />�HN <br />HOV� <br />Oate�_�����'1�.���� <br />Application For <br />PUBLIC WOFsKS PERIlAIT <br />Print or Type Only <br />PunLc WorA� parmi(l '.]�.� <br />nme oeo� . =6�/�� __ <br />Puoi�r. Wo�wa �ce <br />ioui�co S _ <br />lrse Ao�� Fee 1`md $ <br />Naiance Oua <br />z�P Phone <br />_ /1c� ✓ ^��c'I <br />Applican� IAailin�j Address C�ly Zip � Phnne <br />Destfibe PropoSed WOrk <br />Project Address (il known� <br />A�lach lour 14) copies ol plans lo� proposed work � Draw lo scale antl notr Ihe loll�winy as applicable: <br />• Property Lines � Cented�ne ol street <br />• Outline and dimensions ot all eMistmg and • Indicate Nmth <br />proposed slructures on Ihe lot • Show any proposetl �jradin� chan9rs <br />• Exis�ing and proposed utililies • Jhow measuremen�s <br />FERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. m ativance � phone 259•8810. <br />2. All work shall bo peAormed in acrordance with this permit antl curmnt City ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you tlig. TOLL FREE NUMBER 1•800•424-5555. <br />2 o f���� ��-.� ,��2,�.f ��.;.�� �'� � <br />�! �. ,Pxc. ,('o�-,>,, a �C��c�.r� , <br />`�- �' �iQ.�h^= <br />.s 2y- yv <br />ACKNOWLEDGEMENT OP CONDITIONS <br />W <br />� <br />Ow <br />_ / <br />Z <br />� <br />r <br />� <br />� <br />a <br />The undeisi9ned owner/applicant here6y a9ree5 to holtl and save harm� <br />� less the Cny ol Evertit Irom any ,md all claims lor dama9es. costs. <br />I expenses, or rauses ol action Ihat �nay arise because ol inslailahon <br />— I antl maintennnce of Ihe unprovemnnt or other �ighPol-way use hrre�o <br />apphed lar and luriher aprces to remove somc upon notice Irom Ihe <br />Approved for Conslruc�ion Dale City and Io �eplacc puUlic property damageA thereby. <br />FINAL INSPFCTION <br />Appiovetl as Consiructed <br />evercll PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Sir�et <br />Everelt WA 98207 <br />Phone: 259-BB10 <br />Dale <br />Sigr�alurc ol ApplicaN Dale <br />VJORK AUTHORIZED BV TH�S PERMIT MUST BE STARTED WITHIN <br />�80 DAYS OF DATE P[RMIT IS ISSUED AND 7HEREAFTER IS TO <br />BE UILIGENTLY PURSUED TO COMPLEiION. THIS PERMI71,1AV PE <br />CANCELLED BY THC CITV UPON ANV STOPFAGE OF WORK ON THIS <br />� PROJECT OVER 90 DAYS DURATION. <br />