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��� <br />c � <br />H�� <br />k � <br />� � H <br />x <br />��d <br />�/��g <br />y�Y C] <br />t�y� <br />Ny <br />gdq� <br />HZHcn <br />O (/� <br />_ _'.T^m � — , . � . "'�_'_ _ '___"` . ",. _ —. _ — _'_' <br />r _T...� -- <br />;� <br />� Date�i'l. <br />Applicatian For <br />I PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Propased W��rh <br />) j"r_ <br />Mailmg Address <br />� - <br />MaiGn9Hddre— 5�—� <br />, i. <br />r <br />_ ZIp <br />.. ..�...�u _ •i <br />�„�� �. w�,,, ��,�„„ ��� <br />1, <br />u���a o�o� . �i-�!-+tr-- I <br />_ — � <br />�.�;r,�-w�,.,.ee s <br />,o�.,� �e� -- <br />i�se noni �no ram S <br />o.,�T��«o�0 5 <br />— <br />�if ;; 'v <br />.. <br />-`. <br />Phone � i <br />•; - <br />�`� S /iG.i <br />Phone <br />Project Address UI knowrl � �— "�'' ��� /.��� ,/ — — <br />Atlach lour IA) copies ol plans toi Proposed work � Draw to scale anA notr, the followiny as app�icab�e: <br />• Properry lines • Cenledine ol slreet <br />• Outline and Aimensions of all existin9 antl • Indicel:; North <br />proposed slructures on the lo� • Show any praposCd 9radiny changes <br />• Exi�tiny and p�oposeA utilities • Show measuremr.nis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall he made 24 h�s. in advance � pho .�59•8810. <br />2 All work shall be pedormed in aCcordance wilh �hi5 Permi� and cwrenl City o� Everett Desi9n and Consimclion <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig TOLL FREE NUMBER 1•800•424•5555. <br />�� �.-� . �'�- <br />Approvetl lor ConsUuction <br />, / , <br />FINAL INSPECTION <br />qpproved as ConsiructeA <br />i.�i.�iq� PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evere��. WA 98201 <br />Phone 259�BB10 <br />� , , i . <br />/ . <br />j- ' !'. %'`.. <br />W <br />� <br />�w <br />� / <br />� <br />O <br />♦ <br />Z <br />O <br />�w <br />_ / <br />O <br />I � <br />ACKNON7LEOGLMENI Of CONDI71(1PJ5 <br />The under5i9netl owner/applicnnt hereby n{pces to hold and save hnnn- <br />---- less the C�ty ol Everett irom iny antl all claims for tl�ima9es. cnsls. <br />expense,, or causes of acbon Ihal may arine becausr, nl inslallation <br />3ntl maiNenanr.e nl ihe unprovement or o�her n9ht�o4way use he�eto <br />appl�ed foi anA furihur a9�ees lo remove 5amc upon notice Irom Ihe <br />Daie Ci�Y �nA lo rePl.�ce public Praperry dama9ed IhCrehy. <br />� <br />Dale Dale <br />Si9naturc ol Apphcan� i <br />WORK AUTH6RIZF.D OV THIS PER�dff 61U5T �[ STAI77[D WRHIN <br />IPO DAYS OF DATE PHRMIT IS ISSUED ANC� THEREAfTEF IS TO ' <br />BE DILIGCNTLY PURSUED T(� COMPLETION. THIS PERMIT PdAV 6E �I <br />CANCELLfD �Y TH[ CI7V UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OVf[li 30 DAVS DURATION. , <br />i <br />