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� r � <br />ay <br />[�H <br />9HCn <br />H>� <br />�z� <br />c xo <br />�=J H'�] <br />� 3 � t" <br />� H �G <br />'�1 C'] C7 <br />H C�7 O <br />f,� � C� <br />zH� <br />��z <br />HH <br />p�H <br />� qt7 Vi <br />m � <br />H O C�/� <br />�d � <br />.+�.� � <br />��.„ �I <br />�� <br />i <br />i <br /><=::��1 <br />'; '; <br />Date__ <br />qpplicalion Far <br />PUBLIC \PJORKS PERMIT <br />Print or Type Only _ <br />PuOhc Worxs Perm�l • <br />�iaa. oeo�.• — <br />vuoe.worx�Fea 5 <br />toialFee <br />less Avp� Fee �ai0 5— <br />���a��ao�a S — <br />C � <br />� Mailing Address Ciry ZiP Phone <br />nnNicnnt <br />Pro!ecl Address lil known) <br />Attach lour (4) cop�es ol plans lor propOsetl work - Draw to scale and note � Ce Iter�ine of iPee�cable: <br />• Properry Lines • Indicate North <br />s Ouiline antl dimensions o� all e7�sting ar.�l � Show any proposed gratling chanqes <br />pwposetl 5lruclu�2s on tl:e �at � Show measuremenis <br />• Exi5ling a��U pioacsetl utiLtics <br />e��' DO ��OT WRITE BEIOW THIS LINE <br />PERMIT CONDITIONS <br />1. All ca11s for inspection shall be made 24 hrs. in ativance - phone 259•8610. <br />2. Ali work shall be pertormed in accorCance with this permit and turrent Ciiy ot Evereti Des�gn and Construc�i�n <br />Standa�tls and Spec�hwtion;. <br />3. Call LocaY�on Undergre�ind Service 4J hrs. celore you dig. TOLL FREE NUh7BER �•800•424•5555. <br />1 �7,l�l;L \�/G�kS <br />; � � <br />I ,� � <br />•�'cr �vt :t. �CC.c��: : �C� . <br />M ��- <br /><-_ � - :> � <br />ACKNOWLEDGEMENT OF GONDITIONS <br />... + �=�"�;:<;� The undersigned owner/applicant hereby agrees to holtl and <br />'✓�::-`+-r'. - less the Cily of Everelt from any and all claims lor damr: <br />.: � espenses, or causes of action ehal may zrise hecause of <br />and maintenance oi lhe improvement or other right�obway <br />� ���] app�iei for antl Wrther agrees to remove same upon not��. <br />. Approved for Construction Date City and lo rePiace putlic proUerty damaged thereby. <br />FINAL INSPECTION Oate <br />i,oGroved as Conslructed <br />�PUBLICWORKSDEPARTME�T <br />3200 Cedar Slree: <br />� EverMt. W49B201 <br />PhOnc'.259�8610 <br />_—_ —.— �� <br />Signalure ol Applicant <br />N'ORK AUTHCiFIZED BY THIS PERMIT ?AUST BE START' <br />1P0 DAYS OF DATc PFRMIT IS ISSLIEO AND THEFEAF <br />BE G��LIGENTL'.' PURSUED TO COMPLETION. THIS PEPP, <br />CANCELLED 8V THE CITY UPON ANY STOPPAGE OF':!OF <br />vr.n i=/'T n"�n :rl ^,:VS fIIIF' TInN <br />