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� <br />r�." r ii <br />C�1 C+7 <br />'pt-."�H <br />ayxm <br />y xH <br />fC C] <br />H x1 <br />h�tl M'ii <br />iA F� <br />��� <br />OH <br />� �, g <br />(�] Y (7 <br />t" y � <br />yy <br />g d� <br />�� C+7 <br />x H cn <br />H O rn <br />Date� <br />Apptic�lion For <br />PUBLIC WOR�CS PERMIT <br />Print or Type Only <br />Tn POSTING <br />ny AAdress City <br />.�enim Wnrw. Perpmi� p� _S��"�—�^—' 3. <br />emr� Drot . _6._Z,v�oZ�O�AJ —. <br />��,it,�:cwonsFeu 5 —'- _ <br />toin�Fc.• --- <br />iess nnoi Foe cn�n S— <br />e��,��� o�� S �� _ <br />—,�ia r1 ?�AZr f= I(a1�� t�'1ti'-�- �`f- .Sno�ion+r`s-� ffPa90 ��t - 9(oG6 <br />A�plicant Mailin9 Address Gly Zip Phone <br />Descube ProposedlVork <br />Prolect Address Id knuwn) <br />s� <br />Ai�ach fom �4) Copies o� Pl�ns fo� PropoSP.d work � Draw ir scalr and noto Ihe �ollowiny as applicab�e. <br />• Properly Lines <br />• OutLne and tlimensi0ns ol all eai5ting a��A <br />�)fOpoSCtl SIluCWteS On IhC IOI <br />• Exishng and proposed uti6lies <br />• Centerline o� sireel <br />• Intlitate Norlh <br />• Shotv any P��Posed yr.vLnr� changes <br />• Shmv measurements <br />IS L <br />PERMIT CONDITIONS <br />'� � 1. All calls for inspection shall be made 2n hra m advance - phone 259•8810. <br />_' 2. All woik shall be pedormed in accordanco wltn Ihis pe�mit and current City ol Eve�ctt Desiyn and Conslruction <br />� Standards and Snecifications. <br />3. Call location Underground Sen•icc 4Fi hrs. Lefore yuu dig. TOLL FREE NUMBER 1•800•424•5555. <br />�� <br />r � <br />�'��� -- <br />alli�"~� / <br />✓L2` . '.' c'� // � <br />ApP«�ed br Conatr tion � ���� <br />i � <br />1"�� j/1 <br />FINAL INSPECTION Date <br />Approved as Cons�ructed <br />evcrt•t� PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett. WA 9920t <br />Phonc:259�6810 <br />AChNOWIEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />Y/ <br />� <br />O <br />�w <br />_/ <br />O <br />a <br />The untlmsi9netl ownei/aUPlicant hereby agrees Io hold and 52ve hsrm- <br />Iess Ihe GIy ol Everelt from any and all claims lor tlamac�es. cosis, <br />eapenses. or causes of aclion Ihat may e be use ol installalion <br />and mamtenance of the impw emenl o olher rigM of�way use herelo <br />�nn��<<� a luriher o9ice to iem e same up n nolice �rom Ihe <br />City A � eplaC�puUlic pio �e� � etl Ihcre <br />Si9�»t I Applicanl � Uale <br />ORK AUTHORIZED BY THIS PERMIT MUST BE ST�PTED WITFIIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TC <br />DE DILIGENTLY PUf�SUEO TO COMPL[TION. THIS PERMIT MAY P[ <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJ[CT OVER 90 DAYS DURATION. <br />; <br />�. <br />