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��� <br />m�x <br />C, H <br />�H� <br />H�H <br />�H� <br />'�J H '� <br />C/� H <br />L-1 � � <br />H C7 <br />OH <br />H�,g <br />�V n <br />�H� <br />z <br />HH <br />gy <br />H <br />C� t7 [n <br />��h7 <br />ZHcn <br />HOcn <br />Date S i `, <br />App�icahan For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />r��ei,� wo�w; a�,�,�i . <br />eua ocoi . '�1U _ �/.%a � _ <br />Vuobc Worksfee <br />To1al Fe�.! S <br />Le.s POPL Fee Pa�_) $ <br />tla�ante0ue 5 <br />f'nwi.(�oc F k'a ss r�'n :C�cx .2 �P9 ci n za L� <br />' Owner Mailing ACtlress City 2ip Phone <br />?ke f , <br />City <br />Describe Proposed Work �/�n�,e � �4'0 �� t • /f d O '.0 � <br />ProjectAddresslilknown) .�G.77 L�M.CIA-i-n_ <br />Attach tour (4) copies ol plans lor proposed work - Drew to scale and note the following as applicable: <br />• Pronerty Lmes <br />• Outline a�d dimensions of all existing ar.d <br />proposed structures on the lot <br />fl Ezis�in� and proposed u�ilities <br />�• <br />s�a � 75i�-r3 -'3 <br />Phone <br />11 Centerline ol street <br />O Intlicate North <br />• Shmv any proposeA gratlin� changes <br />o Show measurements <br />PERMIT CONDITIONS <br />'�' 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. �II work shall be pedormed in accordance with this permit and curtent Ciry of E�ertl Design and Construct�on <br />�� Standards and Specilications. <br />� 3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800•424-5$55. <br />'v <br />�� <br />f <br />o'a <br />� O 1�'. �� C�1�1`�� �t-_(C—�- V 1�L�=-T�_ <br />�I-`�t'� t'�tC�.) TO T�'T� V,P,C- , <br />N o t-Z �� � l�lnr� �s t��t �-�- ��.0 ��.� <br />-r ��.�-�l ��-- <br />� 8- �� <br />� __ __ _� <br />Approvetl lo� Consiruction <br />FINAL INSPECTION Date <br />Approvetl as Constructed <br />everetl PUBLIC WORKS DEFARTMENT <br />� 3200 Cedar Street <br />Everet6 WA98201 <br />Phanc =59�8870 <br />ACKNOWLEDGE�IENT OF CONDI1lONS <br />� <br />� <br />� <br />The undersi9ned ownedapPlicant hereby agrees to hold and save haim- <br />less the Cdy ol Everett Irom any and all claims lor damages. costs, <br />exper.ses, or causes of action that may arise 6ewuse ot installation <br />and maintenance ol ihe improvemenl or other riyhl-ob�vay use hert;o <br />applied for and lurther agrees to remove same upon notice iwm the <br />City a d to renlace public properly dama9ed Ihere6y. <br />2 �j�/L., <br />ignatur ol Applicani Dale <br />WORK A 1THORIZED BY THIS PERMIT MUST BE STARTED WITHI�J <br />180 DAYS OF DATE PERMIT IS ISSUED AIJD THERF�FTFR IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEHMIT iNAV B!' <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF lM1'ORK ON 7M ; <br />PROJECT OVER 90 U1YS DURATION. <br />