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w <br />��x <br />>Hxt~n <br />y xH <br />fC C� <br />H� <br />�H� <br />Co H <br />�Zp <br />HG <br />OH <br />��g <br />�r n <br />zH�H <br />gNy <br />C] Cy y <br />� � Ci1 <br />H O C�u <br />Y - i3- �� �f <br />Date1�� <br />Application For <br />PUBLIC WORKS RERMIT <br />PrintorTypeOnly TU �0.)j��G___l.-!'-���- - <br />.S <br />Mailinq <br />Describe P�oposed Work <br />Project Address lil knownl <br />� <br />Ciry <br />`:: <br />r��ni�c won, r��m�n . - ,r <br />� �i <br />mac oca� • —c�:-�` _ -!n y� <br />PubbcWorva�ne 5 <br />,���� ��� -- <br />���tsanni FroF.�n 5 — <br />r:�: <br />Bniancnoue S��_ <br />� �,s 3 - n s 44_ <br />Phonc <br />Phonc <br />Attach four (4) copies of plans for proposetl work • Draw to scale antl note Ihe lollowing as appGcable: <br />• Property Lines • CeNerline ol s�reel <br />• Outline and dimensions ol all existin9 and • Ind�cate North <br />pmposed stmctures on Ihe lot • Show any prOposeA 9ratlmg change5 <br />• Existing antl pwposed ulillties • Show measuremenls <br />PERMIT CONDITIONS <br />i. All calls for inspection shall be matle 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in acwrdance wilh ihis permit and current City of Everett Design and Constmction <br />Standards and Specilicalions. <br />3. Call Location Underground Service 4B hrs. betore you tlig. TOLL FREE NUMBER 1•800•424•5555. <br />FINALINSPECTION "' - � <br />Aoproved as Cons�mcted <br />evere« PU�LIC WORKS DEPARTMENT <br />� 3200CedarSlreet <br />Everelt. WA 98201 <br />Phonr.259�9810 <br />w� <br />W <br />� <br />�w <br />_/ <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNO\VLEDGEh1ENT OF CONDITIONS <br />The undersigned owner/applicant hereby a9rees 10 hold and save harm- <br />less Ihe Gty of Everett Irom any and all claims for damages. wsts. <br />eapenses, or causes o� action that may arise bn�ause ol mstallaUon <br />and mainten2nce ol Ihe improvement or e�her r�gh4obway use herelo <br />applied lor and �urther ag�ees to remove same ^pon notice Irom the <br />City a�d to replace pu�lic property damaged Ihereby. <br />� (/�f'/ti+.R �C // ( n.f.a v�--/ �- sd <br />SignaWre ol Apphwn� Daie <br />WORK AUTHORI2ED BY THIS PERMIT h1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREArTER IS TO <br />BE DILIGENTLY PURSIJED TO COMPLETION. THIS PERAIIT MAY B[ <br />CANCEIIED BY THE CITY UPON ANY STOPPAGE OF WOPK ON THIS <br />PROJECT OV[R 90 DAYS DURATION. <br />v <br />