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��� <br />sy <br />A � a <br />C M <br />» N <br />y�� <br />�e c� <br />H xl <br />�9 H '�I <br />f/1 H <br />H <br />'�p <br />ON� <br />��g <br />c� �• o <br />t"y� <br />H �? <br />g`� <br />H <br />o�a^� <br />[i1 <br />xy� <br />HO[n <br />I/ �\ <br />I C_. <br />�� <br />Dzte 5 /G b'S <br />�pplication For <br />PIiBLIC WORKS PERI�JIIT <br />Print or Type Only <br />APplir,an� <br />Mai{Ing <br />r�ouc wo.ee ro.mn . �S �-38— <br />Biap. Don�. • <br />I PoGLCWorF�Fee s <br />TO�01 {P9 <br />�ess Foo� ree aem 5_ <br />Baiance Due $ _`�S �� <br />Fuvo onz- 3�� • vn -a-x�- i� <br />- ssi <br />�. <br />,�Zi—v�+– A.S �roUC� <br />Mailing Address City Z�p Phone <br />Describe Proposed Wo:F <br />Prolecl Addiess (il knom n) <br />Altach lour (4) copies ot plans for proposed work - Draw to scale and note the following as appllcahle: <br />• Properry Lines • Centerline ol street <br />• Outline and dimer.siur�s of all eaisting and • Indicate Norih <br />propos;:ti structures on the �ot • Shcw any proposed grading chanyes <br />• Ezistir� and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. !dl wtls tor inspection shall 6r, made 24 hrs. in advance � phone 259•881 5. <br />2. A�� work shall be perbrmed in accordance wilh this p?rmit and currenl City ol Everett Oesign and Construction <br />Slandards and SpecilicaGons. <br />3. Ca!I Location Undergrouna Service 48 hrs. before you tlig. TOLL FREE NUMBER 1•800•424•5555. <br />�,; E•t'OS.oi✓ furJT.e�i�. <br />,Q i�!'G iCtr n.�T /S To <br />(�,%(G <br />(� f3�c' �EC� tli.t'E O <br />CO.✓TdGT Ci%y' �f <br />ivi� i:✓is .SiTc'. <br />E✓E�c'�' rT Pvdt: � <br />l.JO�P�CS %�f/Si'EGio.e F� /j SiTE /'E�viEuJ Of i�YE <br />�i��of'C.�7'�/ %O DET['�emi�lE TNE Sizc �" LOciS��v✓ <br />oF A' Si�T FE,tiCE" �- sre.��n��°.n '���s �T1�dGi/EO>. <br />�� � �.� <br />"t / 07 S lv .a.� <br />o.� �'r� wp L�-�-. <br />everMt PUBLIC WOHKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everelt, WA 982G7 <br />Phone: 259•831:; <br />W <br />� <br />�w <br />�f <br />a <br />� ACKNOWLEDGEMENT OF GONDITIGNS <br />The undersigned owncr/applicanl hereby agrees to hold and aave haim� <br />le=s the Cily ol Gvarelt Irom any and all r,laims lor doma9es, cosls, <br />ezpen;es, or causes ol acllon that may cnae hecause ol installation <br />and m��ictenance ol the improvement or othdr riqht-ol�way use heretn <br />applicd br anC further agrees to remove saTe upon notice irom the <br />Cily �nA to repiace Public property damaged ihereby. <br />'� "� <br />� - � � --- 2z <br />Signa�ure IAppl� ant atc <br />WORI: A ZEO OY THIS PERMIT MUST BE STARTED WITHIN <br />1A0 DHYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TJ <br />BE DII.IGENTLY PURSUED TO COMPLETION. THIS P[RId1T MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEH 90 DAYS DURATION. <br />