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� � <br />H <br />9Hxti <br />Hz� <br />�i f� <br />H� <br />� H � <br />fA H <br />x <br />o�d <br />��g <br />�V n <br />t"y� <br />C�i� y <br />gey <br />��+ <br />HOy <br />Date' Z� 9� ' <br />PUBLIC <br /><[ <br />1.' <br />C <br />Print or Type Onlyr_ < ` <br />, ,; <br />� � <br />Describe P�oposed Work <br />App�icalion For <br />WORKS PERMIT <br />x �,I ��vS �D• <br />Mailing A�dre�s <br />I�i./ r C �O � �'. <br />Mailing Address <br />I �, 9 <br />FuoLc\vo�xaPermit• -- <br />ela0 Deo�. • <br />PuehcworkaFrta s <br />Tolal Poa <br />Lms AOG� Fau PaiC � <br />0= <br />Baiancc oue S 3S <br />aaz-3zz- yo - n�o-ii-83� <br />Zip <br />i �olect Address lil known) -� -" "` "" <br />Acach four 14) copies of plans for proposed work - Draw lo scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />' ��'a G� <br />�°�CG;3Z � <br />�5�-z�5 �7 <br />T I� <br />• Centedine ol street <br />• Indita�e Nwlh <br />• Show any proposed grading chan9es <br />• Show measurements <br />'�1 PERMIT CONDITIONS <br />1. HII calls tor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />'' 2. All work shall 6e pertormed in eccordance with this permii and current Ciry ol Everett Desisn antl Construction <br />� Standards and Specilications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />' 1 <br />'�I <br />'�' <br />}`, ��LG'7TJ:%L �/fiL�� GLL. /Iti,%vF'�Cc.�(:U �ll+' GcE'y<-[,l?.'-'nX �� `/a..:�v <br />p (/ � y ri <br />pn. ��� J'�It7�ci��� )cxa[w�.l��.J`�.v �7`� f��',Sf. <br />Cl'i/lKcc/nt � <br />� J»��(%G .c�., ��li: �1�.4i . <br />�� j�%70o� � .S � <br />Approved lor Constru tion/� Date <br />����� J' � <br />FINAL INSPF-.CTION bate <br />Approved as Conslructed <br />�_ _ PUBLIC WORKS DEPARTMENT <br />'��3200 Cedar Streel <br />Everetl. WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEM[NT OP CONDITIONS <br />W <br />H <br />� <br />N <br />� <br />O <br />�w <br />_/ <br />O <br />a <br />The i�nders�gned owneVnpplicant herehy agrees to hold and save I�arm- <br />less the City ot Everelt (rom any and ell claims for damaqes, costs. <br />ezpense5, or c.wses of action Ihal may a•ise bewuse of installation <br />and maintenance ol ihe improve� eN or olher righbol�way use hereb <br />applied for and lurther agrees td; remove same upon notice Irom ti��e <br />Citv and to r�lace public �{ro,�er�� damaged thereby. <br />�" � �--� d"C1�-'C� � 2 ' S �i� - <br />Si9nalure ol Applicant Date <br />WOPK AUTHORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEh7LY PUHSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEL�ED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />