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��� <br />H <br />�Hti <br />H�� <br />tC n <br />H� <br />��� <br />yx <br />��d <br />oH <br />��g <br />�Y (� <br />t"y� <br />hi y <br />g� <br />H <br />C�t7N <br />�`�� <br />H tn <br />HOCn <br />' <br />1 <br />Date�Lff�lG' <br />Applic+�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Oniy <br />Owner <br />Mailing <br />Ciry <br />�� <br />Pue�¢ worws pormil .(' [''� �� fy <br />dla9 Uepl � ____—f�f�—�(C� <br />P,�„�,�,va,h,F�,o 5 <br />,o��� ��� <br />Less aoo�. fco Pa�J S <br />o,�.,�« o�� s <br />Applicant Mailin9 Address City Zip Phone <br />r /� <br />DescribeProPosedWork��L+!/i��'L� ��i CiifLl�_ l[iYN/��i �(�1/G.fltd/�� <br />Prolect Address ht knownl <br />Attach lour (4) copies 0� plar.s lor proposed work - Draw to scale nnd note the followirg as applicaUle: <br />• Property Lines • Centedine ol street <br />• Outline and dimensions ol all existing and • Indicate Norih <br />proposed slrucWres on ihe lol • Show any proposed �radinc� change� <br />• Existing antl p�oposed utilities • SLow measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City ol Everett Desi3n and Construction <br />Standartls and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you Aig. TOLL FREE NUMBER 1-800•424-5555. <br />���'" � �!%..�:�=.y� ¢.^.. .<� /'r_,i.. i ^„�(•_[.,1: C/� <br />/ � <br />Approved inr Censtruction Dnte <br />FINAL INSPE:,TION Date <br />Approved as Constructed <br />cvcrrtt PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett. WA 98201 <br />Phone:259�8810 <br />�� <br />r <br />,�r�'� ;.� <br />W <br />H <br />_ / <br />� <br />O <br />`•�J <br />I•1 <br />LJ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi�ned owner/applicant herrby a9rees lo hold and save harm� <br />less the Ci'y ol Evere�l Irom any and all claims for damages'. r.osls, <br />expenses, or cauaes of action Ihat may arise because of installa�ion <br />and maintenanr.e of �'ie improvement or other ricnbof�way use hereto <br />applied for and lurther a9rees to remove same upo� notice irom the <br />City and lo replace public properly damaged �hereby. <br />Si9naiure ol ApPliwn� U��e ��' <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED SNITHI�J � <br />i <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br />BE �ILIG[VTLY PURSUED TO COMPLETION. TNIS PERMIT MAY BL � <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS i <br />PROJECT OVER 90 DAYS DURATION. i <br />—.—__—__--.--_ ._--__. —.—_ —____ _i <br />