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p�',tl C <br />C H <br />N <br />K y � <br />o m o <br />�+p M K1 <br />N M <br />� H � <br />O H <br />� "R� • <br />'y'H <br />H <br />q <br />�� y H <br />(! C N <br />� �y t�tl <br />O y <br />W <br />I�� <br />� <br />Dates���'O� <br />qpplic��icn For <br />PUBLIC WORKS <br />Print or Type On�)' <br />' r„oxc �vo�es v�.n��^: •p �7-� I/c� - <br />oinn �eni • � L��a`�t7 ./ <br />PERMIT �„��,�Wa..s�,—. S_---- -- <br />,o,a,.�� <br />�..,,A�.����.,,,��,�:,s ---- <br />o,n.,. ,.p . 5 _ "—.--__ <br />AAtl�ess <br />I_ip <br />ne <br />�C Q- Citv Ln Phone <br />�uP� ���� Mailing Addres� <br />Desr.ribe; Proposed Work <br />Pioiec� Addre.��slil knowa) <br />Attach lour (41 coples ol p10n51or propOsr,d wo�k � Diav: �o scale and note.�Ceniterline of SVeet l� (' <br />• Property l�nes • Indicate Norlh <br />• Outllne and dimensions ol all ezistm9 and � Show any proposed graAin9 Uian9es <br />proposed 5trudure5 on tt�.� �ot � Show measurements <br />• Eristin9 and proposed uhhiies <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall he made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance wilh this permit and currenl Cily of Everett Design and Conslruction <br />Standards and Specilications. <br />3. Call Localion Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•55 . <br />%� � �,_ �,; ;;- � �-;� ��; � ,.�� �� ��� <br />�;:' /-i-i i <br />lpproved lor Construction Dale <br />INAI INSPECTION Da�e <br />oproved as Consiructed <br />everett PUBUG WORKS DEPARTMENT <br />� 3200CedarSVeet <br />Everelt. WA 98201 <br />� � Phone:259-BP10 <br />� �,��� _., / <br />.S'-�'�i '„ y <br />W <br />� <br />�w <br />_ / <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapp����nt hereby ag�ees to hold and save harm- <br />less the Gty ol Everett Irom any and ail claims lor dama9es. cosis. <br />expenses. or causes o� action that may arise because ol inslallation <br />and mainlenance ol Ihe improvement or other right�ol�way use hereto <br />applied lor and lurlher a9rees 10 remove same upon notice Irom Ihe <br />City and lo rep�ace puhlic property damaged thereby. <br />Dale <br />Sic�n. Wre ol APP�icant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER �30 DAYS DURATION. <br />