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��„ <br /> _ -� <br /> ; <br /> ,�._ ; <br /> ro� d'� �„�,,,�,v�„s���, _,y�-3 - �- <br /> �� H f�A DaIB�-�� t��no o�m.. ������� � <br /> qpplicahen Fo� <br /> PUBL&C WORKS PERMIT ''""'""`°`"`°° g <br /> H <br /> H m�.,���� -- <br /> fC f� <br /> C .�.O less anui Fcc aaia 5 �!' J —_- <br /> �o C� <br /> '; H 41 e.,�,��,�,n�o 5 __—_— <br /> � z �� Print or Type Only <br /> [+1 O L�7 <br /> ��I..f���tttyyy -��-'o�-n-�Y��n 1 -� � ��'����� I� r��ll �t1p 44�1n 5 _. <br /> ��� I Uwne� �� Mailing Atldress r Q}, 7�n phone <br /> ' V /�7 <br /> H � �l� / � ��� �� <br /> Mailing Addres5 C�ty Zip Phone <br /> 'Z N <br /> � H H APPhcant <br /> � <br /> H (�� <br /> C1�V� <br /> �+ Uescnbe Proposed\Nork <br /> �H V� <br /> HOV+ � <br /> /(' �/ — r%'�_. [�;...1 , n, .r � <br /> Prolecl Atldress lil knowN , <br /> � <br /> Attach low IA) copies o�Plans for Proposetl worh- Draw to scale and note Ihe lollov�ing as applicable: � <br /> • PropertY Lines • Centeriine ol street <br /> • Outline an�'dimens�ons ol all exisling and • Indicate North <br /> proposecf siruclures on the lol • Show any proposed gratling changes <br /> • Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITL BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> ���ccc""" 1.All calls lor inspection shall he made 24 hrs.in advance-phone 259•8810. <br /> / �� � 2.All work shall be prrtormed in accordance with this permi�and current Cily ol Everetl Design�nd Consiruclion <br /> � �� Standardsand:� �dNcations. � <br /> i <br /> ��� 3.Call Location Ui .zrground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> 1 W/ / � O <br /> � -r i " <br /> �, ,U:%����zz �. �/,s ��� .-� /�; �•:.:_�<Gc.�� �?,- �. .�,r j, <br /> �—i � <br /> �, � �� �L�Z'1�' �n�ltiu� �•3l'/ r,<_.,t% :_ I� <br /> . <br /> ,I ' �hC(-.-E�L,lr�(C_.1t.: �C'`Lt/i/`�• C�' GC^ / . <br /> � ��r� , <br /> �s.— �t'� c�cu�f��'y C;i� Ti� f-���Lic ' � <br /> ���I ��� /����G ii�jf� C2JJ7��� '� �. � <br /> � '�� ACKNO\VLEDGEMENT OF CONDITIONS <br /> I �1�� The undersigned owner/appGcanl hereby aq�ees to hold and save harm- <br /> less Ihe Ciry of Everelt Irom any and all claims tor damages, costs. <br /> exprnses, or causes ol action Ihat may arise because ol installatlon <br /> ' '=� , / and iiaintenance ol lhe improvement or other righPohway use hereto <br /> �. �4 applied lor and hulher a9rees to remove same upon notice Irom ihc <br /> ve3lor ons ctio Date Gty and to repla�e Publlc properly damaged ihereby. <br /> ��% � 1 - �'- � // � 5- o � j <br /> FINAL INSF'E TION Date �'!� �' ' �'�J� �U � <br /> Approvetl as Constructed <br /> Si9n�ture ol Appficant Datc + <br /> WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> 0 c��crrtt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedai Streel BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evcrett,WA98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER�JO DAYS DURATION. <br />