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��� <br />ro <br />b � C <br />b '3 N <br />y � � <br />K � <br />b � �V <br />N N <br />� � � <br />O M <br />� � � <br />SL M <br />q H <br />e•� M <br />N <br />O N <br />� � r� <br />O �y/7 <br />��� <br />I '�/ <br />Date�.��. _ <br />Applicn. .� For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�-Li✓L%F7 7 : �C.'�.'% ���-C i • . <br />Owner � Mailmc� Address <br />�� rJ ic.�it <br />Applicant Mailing Address <br />Describe PwPosetl Work <br />.�i'� f(.C-'i)'i, <br />Lt <br />{'uel¢ Wn��s Pwnnl+ /— / <br />� oioa Oco�. • —y� / ' <br />i <br />PuOi¢ Works Fco 5 <br />Totnl Foe -- <br />Lesa poo�� Feo ra�d 5 <br />��pU <br />�almcc Oue $ <br />� 'f'2/3/cnFoc�.IAr <br />mn rN. <br />�7 62/�/S/�,e <br />� �r! i � j'�.a �� �d —a"J.S�' 2 <br />.,' ZiP Phone <br />Prolect Address (il knoL ' ` ' — <br />Attach lour (4) copies ot plans � P�oposed work - Draw to scale and note ihe lollowin� as applicable: <br />• Property Lines • Centerline ol sveet <br />• Outline and dimensions 1.�1� existing and • Indicate Nonh <br />proposed slruclure5 on thelbi • Show any proposetl grading chan9es <br />• Existing antl proposed ulilities�\ • Show measurements <br />rnonc <br />1 PERMITCONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259-8810. <br />'� � 2. All work shall be performed in accordance with this �ermit and current City ol Everett Design and Construction <br />� _� Slandards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig: TOLL FHEE NUMBER 1-800•424•5555. <br />J 1_ <br />iG77 <br />J <br />FINAL INSPECTION Date <br />Approved as Constracted <br />��� PUBLICWORKSDEPARTMENT <br />'�s�i 3200 Cedar Streel <br />��� Everelt, WA 98201 <br />�'� Phona 259�8810 <br />W <br />� <br />� <br />N <br />Z <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned owner/appbcant hereby a9rees to h d and save harm- <br />less the City ot Everetl Irom any and all claims lor images, costs. <br />expenses, or causes ol action that may arise because ol installation <br />and mainlenance ol the improvement or other righ4ol�way usc herem <br />applied tor and furlher agrees to remove same upon nohce Irom Ihe <br />City and to replace pu6lic property dama9ed thereby. <br />Signa�ure o� Applicani Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />IBO DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />