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._,.r__ _ _. ---_�."._-_.- <br />� � � _ ��• 1Z:�7.�'�+- <br />� <br />Date_ Z ` TO POSTIiIG %`'�'y"9 <br />�' o <br />Applicalian For �y, <br />PUBLIC WORKS�ERIIAIT <br />r. �Q��g Q$ ��� <br />P�inl or Type Only �� c o o,.i �i o o� o. o 0 <br />vr ul- ro r�i .r. i ti,r m m ra <br />:.� M � N � ~ w � ~ �� <br />Puhlic Wa�1.�Permil � 1����/ <br />e:ea oeo�. • -� 7 ��� <br />v�oi�cwo.k.rea S <br />mi.i rea <br />llStA001 F!! PB�O S <br />a,m�<�� � 5 ZLi <br />/��ll1N �� lNIMOY <br />Applicant MailingAtlt City 2i0 Phone <br />Describe Proposed Work _��.�� «�(T� <br />Pwlect Atldress pf knownl <br />Atlach lour �4� copies el plans for pio0osetl werk- Draw to scale <br />• Property Lines <br />• Outline antl tlimensions oi all existing antl <br />prnposetl slmt�ures on t�e lol <br />• Eristin9 anC prapo5ed u�ililies <br />Ihe Ioilowing as applicablc: <br />• Centetline ol slreM <br />• InEicate NorN <br />• Snow any proposed 9ratling changes <br />• Show measurements <br />PERMIT CONOITIJNS li�' <br />1. All calls lor inspection shall be matlo 24 hrs. in advance � p�one 259•8810. <br />2. All work shall be peAormetl in accortlance with ihis permit anC current City ol Everett Oesign and Con5lmcilon <br />Stantlartls antl Specilications. <br />3. Call Location UntlerBmuntl Service 48 hrs. belore you tlig. TOLI FFEF. NUMBEfl 1•800•424•5555. <br />9, �n_-full rc_ic -�-.�le� ;n�'.��4.�-�,i�o,�-t�e�-,�h �,,,-,�.+ <br />�',r�ec-F c�cwn��ov-�S-i-�-Efe,�,��. <br />�. Co.,,t,�� w,�ih q11 c�r�c+;-F�ons o-� ;ho�'-� Plti-1 <br />., <br />� <br />4 �z <br />Fpprwed for Consimcb Dale <br />�� ? �5 <br />FlNAL INSPECTIGN Date <br />Appmvc0 as Conslmctca <br />�Pl1BLICWOFKSDEPARTMENT <br />9°00 Cetlar SVee1 <br />�«T� Evcrell.WA90"e01 <br />Pnone:.^5�J�B810 <br />W <br />H <br />� <br />� <br />O <br />� <br />Z <br />0 <br />� <br />� <br />0 <br />a <br />ACNNOWLEDGEMENT OF CONDITIONS <br />T�e undmsignetl owneqapplicaN hereby agrees �o holtl anC savC harm� <br />less Ihe City ol Evereti Irom any anG all claims lor aam,'ges. rosis. <br />e�pense5. or C2uses ol at�ion Ihai may arise becau5e ol inslalla�ion <br />antl mniN2nance ol �he improvemen� Or O�her righ4of�wty use M1ereto <br />;appheG lor and Wrther a9ree5 to remr,ve same upon notice Irom �he <br />Cily antl to repl e pubbc Oroperlytlama�ed ihereby. <br />� � "1: . , - , <br />' � <br />l,, ; ( �`.�,' lr..,,,.�c� � ��� .-Z <br />S g ature oi Appliwnt Dalc <br />WOI : AUTHORI2ED BV THIS PERMIT MUST BE $TARTED WITHIN <br />180 DAVS OF OATE PEflMIT IS ISSUED AND THEREAFTER IS TO <br />�E OILIGFNTLV PUHSUEO TO CO�dPLETION. THIS PERIdIT MAV BE <br />C:.�JCGL LCD �Y TIIE CITY 11PON ANY SiOPPnG[ OF 670RK ON THIS <br />PROJfCiOVER 90 DAYS DUHAIION <br />