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x C'�7 <br />[�7 C7 <br />Y �3 <br />,o�x <br />a � <br />r s �' <br />H 93 <br />y ZH <br />K C] <br />H 7J <br />o zo <br />'sJ H 7J <br />V1 H <br />H C <br />� O� <br />OH� <br />��g <br />�. �q <br />�y H [�7 <br />r r-� y <br />8 �' <br />H <br />CC]"� C7 f� <br />[s] � C�7 <br />y Cy7 C�n <br />�� <br />.- - <br />� <br />Datey<<,��C � <br />npn��cation For <br />PUBLIC WORKS PERMIT <br />Print or Type Onl�/ <br />G <br />Mailing <br />��,�:i ocoi . ,� o --�--__ <br />i � �1S-- <br />n�,�,i,c Wo�ks rne <br />totai Fx 5 <br />� cs nno� v���. r,�,n 5 <br />� c�u� S <br />y�zoG ,; <br />Zip p <br />O'/.I ,�/ c <br />Applicant t.taihn9 Atltlress Gty Zip Phon¢ <br />0��2 <br />Describe Proposetl Work .Cn t< do, gS/e .l .'�El�Aiti' _ <br />Project Address (il known� <br />Attach lour 1�I cop�es ol plans �or piopose0 work - D�aw to scale antl nota Ihe foilowing as appliCnble. <br />• Property Lmes <br />• Outline and Aimenswns of all ezishnq .�nd <br />prOposed 5lructurCS on the IOI <br />• E.istiny .intl P�opLsctl uLlq�os <br />• Centerhne ol slreei <br />• Intlicalc No•�h <br />• Show any proinFecl ur�Amq ch.myrs <br />• Sernv m�•:uw��in,�nt, <br />HIS �I <br />PERId1T CONDITIONS <br />1. All calls 10� inspeCtion shall he inad•• 2�3 hrs in ativdnCe -{�hOne �$9•B$� 0. <br />2. All wOrk Shell bC pBdOqnCd in ;±cc � nce v; dh Ihu permil and current Gty ol [cme;t Desi9n antl Conslruclion <br />Standards and 5peahwt��ns. <br />3. Call Loeation Undergrnund Service a8 hr, h: iore you dig TOLL FREE NUMBER 1•800-424•5555. <br />Approv�A lor Construc�ion <br />"f v� � i c I-1 a� k s j�,c.�.-, �`1— f��"r �C �.� ��z�."Y� <br />9���y � <br />�ceu-E�- bt� ` �`-�- <br />nc.r:r�on�Eocr:raciai ot-coNoilroNs <br />W <br />� <br />_ / <br />Z <br />O <br />� <br />� <br />0 <br />a <br />The untlertiq�netl ewner�ipphcanl hereby agices Io hold and save hamr <br />less Ihe City ol Everelt irom any and all claims lor damages, costs. <br />eKpenses, or Causes ol lCiion Ihal may arise because ol installahun <br />antl m�lntenance ol Ihe improvement Or olher ri�hPOF�.vay use here�o <br />applieA for and luri er nqrces �o remove s2me upon nohce hom thn <br />Da�e Gty anA b replar public property dama�eA IhereUy <br />FINAL INSPECTION Date _. <br />Approved as Consiructetl Si9nalwe o� Apphcant D:ite <br />evcrrtl PUBLICWORKSDEPARTMENT WOFK �UTHORIZED BV THIS PERMIi h1UST BE STARTED WITHIN <br />0 3200CedurS�ree� 180 DAYS OF DATE P[RMIT IS ISSU[D AND THEREAPiER IS 1J <br />[vcrelL WAll820t [�[ DILIGENiLY PURSUED TO C061PLETION, THIS PERhtIT M11�1Y B[ <br />Phone 250�dU10 (:ANCI'.LLLD [3y TII[ l'IiY UPON dN\' ST(1PPi1GE OF IVORK ON 1H�S <br />PHOJLCi 11VER 90 DAVS UUHillION. <br />