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� y <br />O�H <br />9Htn <br />H�� <br />FC O <br />'+tl � 'i1 <br />H� <br />xp <br />OHd <br />��g <br />QY (7 <br />C"y� <br />gyy <br />oCv�i <br />�O� <br />1 <br />' <br />� <br />� <br />r.r <br />Date �f � <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />���a - � <br />Maili�g Address <br />Describe Propused Work <br />Project Add�ess (il known) <br />FuOI¢ 1Ya�b Pa�mil • <br />o��o. 000i. a 4/ � 7 l' J e <br />Pu41ic Wo�ka Foe <br />lolnlFee S <br />Lev ApO� Poe PaiJ S <br />Oninnco Ove S <br />� <br />_�-ue/u,� 1��ey 25-�- 73/Y <br />Cily Zip phone <br />�r.a� <br />Zip Phono <br />Allach lour (4) copies ol plans lor pwposed woik � Draw to scale and nole Iho lollowing as applicable: <br />• Properly Llnes <br />• Outline and dimensions ol all existing an� <br />pmposed Struclures on Ihe lol <br />• Ezisling and proposed ulililies <br />• Cenlerline ol sUeel <br />• Indicate Norlh <br />• Show any proposed gradinp changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•$8� O. <br />2. All work shail be pedormed in accordance wilh Ihis permit and curren� Ci�y ol Everetl Design nnd Construction <br />Slandards and Specilications. <br />3. Call Locatlon Underground Service 48 hrs. betore you dig. TOLI FREE NUMBER 1•800•424•5555. <br />Approved lor Conslrucllon Uato <br />FINAL INSPECTION Uate <br />Appwved as ConSlruGed <br />everett PUBLICWORKSDEPARiMENT <br />� 8200CedarStreel <br />EvcrMt, WA 98201 <br />Phana 259�BB10 <br />l�CKNOWLEDGC-MENT OF COND�TIONS <br />�� <br />W <br />H <br />_ / <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/anPlicanl horeby agrees to hold and save harm• <br />less Ihe City ol Everetl Irom any and all claims lor dameges, cosis, <br />expenses, or causes of aclion Ihat may uiise bacause ol inslallation <br />and mainlenance ol Ihe improvement or other ric�ht�o' '�; use herelo <br />apP�ied br and Imlher ac�iees to rmnove same upon ice Irom the <br />C�ty and lo mplaco publlc propeily dnmaged Iherahy. <br />Signalure ol Applicanl �alo <br />WORK AUTVIORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />�E DILIG[NTLV PURSUED TO COMPLETION. TIiIS PEfiMIT MAY BE <br />CANCELLED BY TIIE CITY UPON AN1' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 UAVS DURA710N. <br />