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_�^ <br />ttl C�1 � <br />�O'.�� x <br />>yN <br />y � i-�i <br />fC C] <br />H 7J <br />'�tl H'� <br />fA H <br />Cl1 O ii7 <br />H <br />��g <br />�. � <br />Cy� <br />HH <br />�y y H <br />ccpi C7 y <br />C: � Crs1 <br />HOy <br />C� °; �_, �. > -'y- <br />1 �',--��C� <br />Date <br />qpplication Fo� <br />PUBLIC WORK� PERMIT <br />,-_��, --> <br />� <br />Pep�.clVo�Fe � � �J <br />r` <br />wna oeo�� • - <br />��mec worva rca 5 ---- <br />,,;,.�,ea <br />��z� nnoi F«e Pa��f S— - <br />��,i.,�o�o�v 5 �Cr'� <br />Print or Type Only —" <br />Tn nncT�t�(; �-19-`i? <br />Mailing Address <br />Describe Proposed Work � � � �" <br />Prolect Addres5lil known) —� `-' � " �` ^' �- "" `-' �'� <br />Atlach lour (4) copies ol plans for pro�osetl work - Oraw to scale antl note the �ollowinq as apP����ble: <br />• Properry Lines <br />• Outline and dimensions ol all e.isling and <br />proposed structures on Ihe lot <br />• Existing and proposed utilities <br />• Centerline ol stieel <br />• Intlicale Norlh <br />• Show any proposedc�ratling changes <br />• Show measuremen�s <br />Phone <br />PERMITCONDITIONS <br />7. All calls lor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accortlance wilh ihis permil and current City of Everetl Design and Conslruclion <br />Stantlards and Specilications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />-q. k��r���c��,r `�+i�\�.c. INs:�-►lL� Iz" �Pirat-��='TC.l2 <br />�.cti( c_tz�-1 E' c.v� ��1�' A�c�Nc� Pir_r\��.inCat L.iI�,�E: <br />�,� b�C�7Z. 7i� I VF kJ^�C V�-C-�'-� C:�tJ:�i�'V i Tl Cti <br />1��--c_-� � lv � . <br />� -���..`� �1� � k��. I /�� �., <br />Approved lor Cons!ructjory / Date <br />C/ <br />_��''%.�:/-� - �9' <br />FINAL INSPECTION Datc <br />App�ovetl as Cons!ructed <br />���iqpry PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar Stroet <br />Evcrett. WA 982J1 <br />Phonc:259�Bn�0 <br />ACKNOWLEDGE�IENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />♦�A <br />V♦ <br />O <br />a <br />The Untle.rsign�+d ownBr/applicant hereby ac�rees t0 hold antl save harm- <br />less the City of Everetl Irom any and all claims lor damaqes. cosls. <br />expenses. or <�.auses ol action Ihat may arise because of installation <br />and main�enance ol Ihe improvemenl or other righDobway use hereto <br />apphed for and Iurlher aqrees lo �e�nove same upon notio: Irom Ihe <br />Cit� and to r �ace public pronerry ma9ed therebq. <br />Sic�n, tuC re o� Applir.anl � ate <br />WORK AUTHORIZ[� BY THI'.i PEFMIT MUST BE STARTED WITIiIN <br />1�0 DAYS OF DATE PLRAIIT IS ISSUED AND THFREAFTER IS TO <br />BE DILIGFNTLV PURSUED T(� COMPLETION. THIS PERIdIT MAV BE <br />CANCELLED BY THE GTY UrJN ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9L DFYS DURA710N. <br />� <br />