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�"� <br />� <br />c 'D � <br />�Hc, <br />��� <br />H 7c1 <br />�y� <br />: <br />�O� <br />H <br />�I��g <br />y� V C] <br />H <br />zH <br />�yH <br />H <br />C] C7 V� <br />��y <br />H O V� <br />+-•� <br />Date i � /`%� ° <br />� Application For <br />PUBLIC WORKS PEHNiIT <br />� TO POSTIN( <br />Print or Type Only <br />Ma <br />Describe Proposed Work <br />f�1 <br />Address <br />� S�i�zl�`Z � <br />`>&�o � <br />c�ry rp <br />c�ry z�n <br />v�ni,� wo��s pmmn • �7+/ — /Z� <br />eieq. o�o� • �^C.-IA.%!0—„J-- <br />awn�� wo�k9 reo <br />roiai F,e 5 <br />LassAOPI pee Pa�O 5 _� <br />oa�.,��.,��� 5 ao�— <br />Pmject Addressl�l knownl ���U7 ^ �� I h � -� �r - <br />Attach four �4) copies ot plans lor proposed wo�k - Draw to scale antl note the lollowin9 as appliwhlc: <br />.• Proper�y Lines • Centedine ol sireel <br />-• Outline and dimensions oi all e�istin9 and • Indicate North <br />proposed sirucNres on Ihe lo� • Show any propused c�radin9 changes <br />• Eaisiin� anA p�oposed u�ililies • Show measuremenls <br />W <br />Nnone <br />• PERMITCONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2 NI work shall be pedormed in accordance with this permit and current Cdy of Everetl Design and Consiruc!ion <br />Stantlards and Specifications. <br />� 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />i <br />�, Gii`L��.�._. <br />i�1r�k i r1vNl <br />�C1 i ,ZONT <br />�,L � \iC \\�A�"� TJO 1 ���1_0����� , <br />ZO� +�l�viNC_ 1�1tT,`;���=,�� ��\Lt�L��_ � <br />i�itc�r�Li�T`-� L� �J� , . ;�-1 ; , i �� .s � �.� <br />r �v�_�i '-��� �:����--'r;_, <br />� <br />C 1 ' I(L'r <br />, � ,{ri �Cee, � <br />, Approvedlor,Consiruclian Date <br />II <br />FINAL INSPECTION Dalc <br />�'� ApprovedasConslructed <br />' everett PUBLIC WORKS DEPARTMENT <br />�i � 3200CedarSlrccl <br />� Everett, WA 98201 <br />� Phona 259-8810 <br />i <br />� <br />O <br />� <br />V / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unders,yned owner/applicant herel�y a9rees to hold and save harm- <br />1055 �he Ciry of Everelt Irom any and all clai�r'�s for dama9es, costs. <br />ezpenses, or causes ol achon Ihat may arise 6ecause of installalion <br />and mamtenn{�ce ol Ihe improvement or other ri9hl�obway use hereto <br />apphud lor arJd furiher �9rres to remove same upon notice Irom lhe <br />Cily and �o l�place pu�h FroUelIty dama9ed ihereby. <br />NM Q �� .'/ `i'�r� "-F• i/ %� �J� <br />.�—. � <br />Si9nature ol Applicant ���` <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STAR7ED Wl7tilr: <br />180 DAYS OF DATE PERMIT IS ISSU[D AN� THEREAFTER IS 10 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY E�L <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON TI-II� <br />PROJECT OVER 90 DAYS DUFATION. <br />R <br />� <br />