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t�] L�l � <br />A�x <br />C H <br />a Hx !/� <br />y X ��-+ <br />rC c� <br />H �1 <br />cxo <br />'iJ H'il <br />[n H <br />y r <br />� o �i <br />H t7 <br />O H <br />��g <br />(�] V �i <br />zy� <br />� F-+ H <br />g �' <br />c� C7 N <br />� r� r <br />x H t�/� <br />HO[n <br />Date � -�+t��—,i <br />qpplica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuO�KWO�bVO�m . <br />O�tl�1 DeP�. a L .- <br />Pimi�cWo�ksfeo 5 <br />r�,., �ea <br />LcssAPpl FeCPanl 5 <br />palanco0uc 5 <br />Applicant <br />Descri6e Proposed Work <br />Address <br />� <br />City <br />ap <br />ProiectAddressl�lknown� __ _ �-�� <br />Attach four (4) copies ol plans b�• Proposed work - Draa to scale anA note � CQo1,erline of stPee� ahle�. <br />• Properly Lines • Indicate North <br />• Oulline and dir�ensions ot all existing and � Show any p�oposed gradin9 changr,s <br />proposed strucWres on the lot � Show measurements <br />• Existing and proposed utilities <br />J� <br />Phonc <br />PERMIT GONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance wilh this permit and wrrent City of Everett Design and Conslruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you di9. TOLL FREE NUMBER 1-800•424•5555. <br />+��.,� �-�.k��� �('�1D� �=��� ��L �1ti� c_c.-� � i <br />-��'� (���. � �-�-�-� �--�1 l� I�,I L� D S� l�l �1 �— <br />� � T�1 z A � � � �..', �=k� P�t �T � �� �l :J �.�> i. � ��L� <br />1„I I L L a3�= 13L� � L i c'����1�_ Z�- x 1 S j!�-' C�_> <br />�� t TT � �1.1 C-IZ <br />ApproVed lo� Con5lrUction <br />FINAL INSPECTIO?.' <br />Approved as Constru:.�ed <br />everetl PUBLIC WORKS D[PARTMENT <br />� 3200 Ceda� Street <br />Evcretl, W� �8201 <br />Phonc'. 25D�E7E3t0 <br />� <br />Date <br />Date <br />W <br />� <br />— <br />Y / <br />H <br />� <br />� <br />a <br />ACKNOWLEUGEMENT OF CONDITIONS <br />The untlersi9netl owner/applicant hereby a9rees to hold and save harm� <br />less ihe Ciry ot Everett irom any and all claims lor damages. cost• <br />expenses. o� causes ol acllon Ihat may arlse because ol installation <br />and maintenance ol the impwvement or other ri�h4of�way use herelo <br />applietl for anA lurthe� a9rees lo remove same upon notice ��om the <br />Cily and to replace public property dama9ed thereby. <br />Sic�nnture of AppGcanl Date � <br />WORK AUTHORIZED BV ?HIS PERMIT MUST BE STARTED WITHIN , <br />180 DAYS OF DATE PERMIT IS ISSUED AND T1�IEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPL[TION. THIS PERMIT �tAV BL <br />CANC[LLLD BY THE CIiV UPON ANY STOPP�IGL= OF N'ORK ON 7HIS <br />PROJECT OV[R 90 DAYS DUR�TION. <br />� <br />