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��' <br />��r�i <br />>yc�n <br />H�H <br />fC C� <br />H x1 <br />oxo <br />�7 N A1 <br />V1 H <br />H [" <br />� H �G <br />ON <br />H^�g <br />y. V � <br />ta" y � <br />r+ y <br />g� <br />�d� <br />��r <br />D7 <br />r3 O C/� <br />Date—l-Sl��O / !'� <br />qppliCatiOi. .�or <br />p�JBLIC WORKS PERMIT <br />Print or Type Only TQ pCSTING. �- s� <br />V: '"" <br />('�iUhc WprMs —EfY <br />eieo or�. • — iI�'�.. <br />PuO�¢Vlor�sFeo S, <br />,o,.,, F�� <br />tessAnu�.G¢ePaio 5 <br />Cnlancr Oue $ <br />Desc�ibe Proposed Work <br />ailing Atltlress <br />Prolect Atlaress Iil knownl _ <br />Attach four (�) copies of plans �or proPosed worh � Draw to scale antl note the lollowinq as apPlicable: <br />• Property Lmes • Centedine of slreet <br />• Outlme and dimensions of all e<i;ung a�tl • Intl�cate Nonh <br />preposetl siructures on Ihe lol • Show any proposed 9ratling chan�es <br />• Existin9 and proposetl utilities • Show measurements <br />PERMIT60NDITIONS <br />�� 1. All calls lor inspection shatl be made 24 hrs. in advance - p�ione 259•8810. <br />� 2. All w�ork ghall be G-Normed in accordance with this permit antl current Gty ol Everett Design and Construction <br />�'" � Standards and Specihcations. <br />3. Call Location Undergmund Service 48 hrs. belore you Cic�. TOLL FREE NUMBER 1•800•424•5555. <br />Approved for <br />FINAL I�"'.^I <br />Approve� .-. <br />ever�it <br />� <br />� � i i') -// /�, ' � /'. <br />7-" G?LGC� ,.._��_�:-. �' .:. �r,. � r .. ,. . . : i.,_ ,� <br />LC <br />ion <br />";onsiruc�ed <br />PUBLIC WORKS DEP�RTMENT <br />3^00 Cedar Street <br />Everett, WA 99201 <br />Phone: 259�8810 <br />% �'/� �! <br />� <br />� <br />W <br />F" <br />�w <br />_ / <br />Z <br />O <br />� <br />N <br />O <br />a <br />ACKNOWLEDGEMENi OF CONDITIONS <br />The undersi9ned owneUapPlicant hereby agrees �o hold and save harm- <br />less ihe Cdy o� Everelt Irom any and all claims lor Aama�jes, costs. <br />eapenses, or causes of action Ihat may arise because ol inslallation <br />and mainlenance of Ihc improvement or olher ri�ht�of-way use hereto <br />opphetl �or and �mlher a9rees to remove same upon notice iwm the <br />Dale City and to replace pu6lic pmoerry damaged ihereby. <br />Date pa�� <br />Si�na�ure o� AppliCant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 �AYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TH� CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJF.CT OVER 90 DAVS DURATION. <br />