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�h� <br />9 �3 <br />C�H <br />>Hrn <br />C S9 <br />y Z F�-+ <br />K Q <br />H �1 <br />o xo <br />"+J H'� <br />H N L~"' <br />� y� <br />�^�g <br />y V n <br />9 �� <br />` HH <br />g`� <br />H <br />C] C7 � <br />��� <br />Z H �n <br />H O tn <br />, �_., _. a.�. __..� - <br />D'ate ��� ,L'� % ,�(J <br />�'�� <br />Application Po� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />' ow ,�� <br />ng <br />p s <br />�'..:�,'-r. \Vorks Permil • <br />t��na o�w • QQ� K' RCI� <br />�,���,�wo,��.e� 5 <br />,��.,� ��,. <br />��„s �es re,• �a�n 5 <br />❑aiancuDuc S <br />_ Sr�%/> > � <br />Apphcant Mailing Nddress Clty Lp Phone <br />De5('rib� PrCpo5etl Work �1��%�L�G. L���.%��liV� 12E/'A/k.��'P'LAGE' P�v:.CNt'S '� 5r l, <br />� ProjeclAdtlre&sldknown� 2f��,a+tZSLis%fLL- _.__ .__ _ __ _ <br />Altach fom Id) cooies ol plans lor proposed wo�k � Dra;. F.� �.r.d�� ;mcf nate'••.e tollowm9 as apphcw'-� <br />' • Properly Lines s Crnterline of Sirec� <br />� • Outhnc a��d dimcns�.r,nc nl .�II e•.�.,I.nr, .u�d • Ir.�7�rute Nor�h <br />proposetl siruclures un Ih�. lot • Snow �ny P�oPoc�•q:�iatl:m; ��.henu•�� <br />• Existinp �nd proposRd ut�lnies • 7how muaswomenL <br />PERMIT CONDITIONS <br />t. Ali caus Ior inspeclion shall he made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be peAormetl in aecortlance with Ihis permd antl cuuent Gty ol Evrrelt D�.�siyn and Construction <br />S�andards and Speci6catmn5. <br />3.Call Location Untlergiuund Service 4A h�> t:el���u y�;w d�y TOLL FREE NUMBER 1•800•424-5555. <br />'J <br />`UG'•��..i.'^./� `,�C.;.:../�i', <br />/ <br />for Consiruclion <br />FINAL INSPECTION <br />' Approved as ConslructeA <br />�, ererr�t PUBLIC WORKS i1EPART!dENT <br />� 3200 Ceda� Street <br />[veicP, W� 98_Ot <br />Phone.353-8�10 <br />i <br />J . <br />� <br />o ' <br />ACKNOWLE[JG[h1f_Nl O� �ONG'ilONS <br />The widcrsipaed owncr/appliwnt'iereby a9wes to holA and save hann� <br />--- less the City N Everelt Irom any and ait damis lo� Aama9es. r,osis <br />ezPei�ses. or causes ol :tction ihai may atise hetausa nl installa�ion <br />antl maintenance ol the improvement or other nght-oFway usc heretn <br />npphed lor anA furiher ac]rees lo rernove same upon notice Irom Ihe <br />Date City and b replace P�iblic prapeiry d:una9ed iherr.by. <br />Datr, <br />Si9naiurn of Apl��icant Dalc <br />WORK AUTIIGRIZED BY THIS PERMff MUST B[ STARTED WITHIN <br />180 DAYS OF DA?[ PGRMIT IS ISSUED ^ND THEREAFTEfi IS TO <br />BE DILIGLNTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANC[LLCD HY 1F1E QTY UPON ��JY STOPPAG(: OF WO(iK ON THIF <br />PROJ[Ci OVE.R 90 Dr1Y5 f7URAlIpN <br />