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��i� <br />A�x <br />M <br />9 r'a p� <br />4 <br />H�� <br />o�o <br />�V1H <br />� <br />o�d <br />��,8 <br />G). o <br />H <br />t' y <br />ri y <br />8y <br />� <br />C] C7 V� <br />��� <br />H O V� <br />�"'� r <br />I � �' <br />� � <br />,-- <br />� ,�I <br />Date�_;1'�J� <br />Apphca�icn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />t' '� — " - <br />Gu01i[ N'O�ki Pc!1�•n� { /� <br />eiap Oeoi • 1J1.J�_GS-�� <br />Pupl¢WorYeie@ S <br />r�,.� F� <br />tas�oo� �ee vem 5 <br />eeunc• Dun S <br />�Yi`� <br />appi�cant Mad�ng ndd�ess Gry Z�p Phone <br />Descnbe ProposeC Work � )� � . ��1-1� V x � �L �J <br />Pro�ed Adtlress lif knownl <br />A��ach t0ur �4� cOpies O� plans 1or propOsetl work - �iaw Io ScalU and nUle Ihe �o�lOwing as appliwb�e. <br />• Property Lines • Cenlerhne ol street <br />• Outl�ne pna dimensions of all existmg and • Indical�: Norlh <br />pieposetl siructures on the �o� • Show nny proposetl gr. tl�ny chanyes <br />• ExiyPng and proposed uliLties • Show measwements <br />NUT <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City ot [verett Design and Construction <br />Standards and SpeciliCations. <br />3. Call Location Underground ServiCe 48 hrs. befo�e you dig. TOLL FREE NUMBER 1•800•424•5555. <br />}�f%.��c/U.�+a/�.���� �t/C>l.E'c�.�i+.ea� ._L • � /Z-.�.�d9 <br />�7Y��J <br />• 7 �i�_.Q.u�a�.� '�;�ce_a.f COnC.ca�.7'� Sfe�u .%'-GJ.re2 �e,/ 4. �o ��Qcn+ls�e.�t� <br />�L SLyf�/ �L f�a{�c� �a2�+�Ca:✓ Qt)it[Lnu.ry �fc�`GGN �.�..0 Gc-Ly. <br />�sz„'.. �7Q.��� �� �r <br />S L'o�.�' F�l�t �tG�. �.��:� ,�'<:e�-�z �,� �-�<.� w��� <br />s�ut�� . <br />Approved lor Consiruction <br />FINAL INSPECTION <br />Approved as Constmcted <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Stmet <br />Everelt. WA 98201 <br />Phone:259�8810 <br />W <br />H <br />_ / <br />� <br />� <br />�� <br />�w <br />_ / <br />O <br />a <br />ACKNOWLEDGCMENT OF CONDITIONS <br />The under;igned owncr/applicanl hereby agrees to hold and save tiarri� <br />less Ihe City ol Everett Irom any and all claims lor damages, costs, <br />evpenses, or causes of action ihat may arise because of inslallation <br />and maintenance ol Ihe improvement or Olher right�ol�way use h¢reln <br />applied lor and lurther agrees to remove same upcn notice Irom the <br />Cdy and to replace public pwperty damaged ihereby. <br />WO�Ri( AUTHORIZED THIS PERMIT MUST BE STARTED WITHIIJ � <br />1Bp AYS OF DAT -RMII' IS ISSUED AND THEREAFTEfi IS TO <br />BE LIGENTLV PU 'UED TO COMPLETION, THIS PERMIT MAV BE <br />CMJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEP 90 DAYS DURATION. <br />� <br />; <br />r;(jy�l <br />r: :� "� �f <br />'t <br />