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.Z'n r I1 <br />h h <br />ay <br />,ozx <br />a H [/� <br />y �H <br />� H� <br />"�� H 'TJ <br />[/J H <br />y r <br />�x <br />H C7 <br />��g <br />� V �C] <br />rHz <br />HH <br />g� <br />H <br />C] t7 N <br />��� <br />H O V� <br />Date �"� <br />: �a <br />Applicatinn For <br />PUBLiC'WOF%KS PERMiT <br />Print or Type Only <br />. <br />Pa�i�c 1Vorwa Permil • � / <br />�_.+ DI�ODc01.a �/���0/%/_.... <br />PuliLCWorkSFcC S <br />iotnl Frc <br />Lrss ApDI Per Pa�d 5 <br />A.,�,��o o�� s <br />,� Y�;� � 9g�� <br />�Ity Zip Phone <br />Applican�� M1tailing Addres5 Cdy Zip Phone <br />� <br />. i �, , ., . n_ <br />Ccscribe Pwposed Wo�k <br />Proier.t Address 1�1 known) <br />Altach lour Ih� copies ol plans br proposed work � Diaw to scale anA note Ihe lollowmg as applicable. <br />• Properry Lmes • Centedme ot slreel <br />• Out6ne and dimens�m�s ol an ,�,.�,t�ng an�7 • Indir,ale Norih <br />proposed siruclures on the lot • Show any proposed graAin�� chanyes <br />• Eaistm9 anA nroposed ulil��Lc, • Show measuremenis <br />LOW THIS L <br />PERMIT CONDITIONS <br />.,,, � 1. All calls br inspeclion shall be matle 24 hrs. in advance - phone 259•8810. <br />� � 2. All work shall Ue pertormed in accordance with Ihis permit and current Gty ol Feerett Desi9n anA Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you diy. TOLL FREE NUMBER 1•800•424•5555. <br />�C/ �y�c-cl GciO�z <br />-�vi-U-kda-�.;�, . <br />��tu�.J JunQ� <br />2,,�/� ��L�,-L:.E� . <br />T �23.uT ! ✓O� �y��Lt-c0 7`07 �f i.� <br />Hc���.v � CoY�..-��� ��cJ <br />tv-t.�� �2Urn.e� ��a-m�c, �'«c.�<.J <br />�, <br />,:pproveA for ConatrucUon D;ue <br />FINAL INSPECTION <br />Appraved as ConsUucted <br />�wrrt•It Pl18LICWORKSDEPAFTMENT <br />� 3200 Cedar Slreet <br />Ev��rett. WA �J8201 <br />Phnnc. 259-��10 <br />������f� <br />, -� -�� <br />W <br />� <br />� <br />� <br />Z <br />� <br />�CKNOWLEOG[MENTOFCONDRIONS <br />The undmsi9ned ownedapplicant hereby ae�rces to hold ano s.ivc haiin� <br />Icss �hc Cily ol [verell Irom any and all claims lor d:�may�'s, cos�s. <br />evpenses, or causes ol action ihat may arise bewusr, of Inslallation <br />and maintenance ol the impro�•emenl or olher n�hl�of�way use hemto <br />applied lor and lurther a9rces lo iemove same upon notice Imm the <br />City and to replace pubGc pwperry damaged thereby. <br />Date <br />Signaturc of Applicant Dalc <br />WORK AUTHOFiIZED BY THIS P[Rh11T MUST BE STARTED WITH�N <br />180 DAVS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br />8E DILIGENTLY PURSU[D TO COMPLETION. TNIS PERM1IIT 61AY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOf7K ON THIS <br />PROJEGT OVER PO DAYS DURATION <br />