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���u <br />a � <br />H�� <br />/! C! <br />� � � <br />��R��''1 <br />�� <br />QM� <br />Ys. M <br />C" y <br />F+ <br />W <br />�y H <br />W ��" <br />OW <br />.:, <br />Date�U I <br />Application Far <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work <br />Prolect Address Iil known) <br />Attach lour 14) copics of plans for proposed work � Oraw to <br />• Property Lines <br />• OutLne antl d�mensions ol all eaisting and <br />proposetl structures on the lot <br />• Eaisiing and proposed ulilities <br />o„ei�c wmAa P�vy-��,,�q- �j� Q <br />aino ouoi.,.—u-1- -✓`n�.���0 � <br />Peeec wmkn Fce 5 <br />iolni Fee <br />.ess nnp� F�r Pam S <br />paiam;o Our <br />Zip Phonc <br />and note Ihe loltowing as applicahle: <br />• Centerline of streel <br />• Indicate Norih <br />• Show any proposed 9radin9 changes <br />• Show measuremen�s <br />IFERMIT CONDITIONS <br />L� 1, All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />I�I 2, All work shall be pedormed in accordance wilh ihis Uermi� and current Ciry ol Everell Design and Conslruction <br />i Standards and Specifications. <br />� 3. Call Location Underground Service 48 hrs. belore you dig TOLL FREE NUMBER 1-800•424•5555. <br />i <br />� � <br />� �� <br />� <br />�/,� ��/f� �,�'� �'r/o� �¢�U�+.�� <br />L� c� c���'�� <br />"' //-��'89 <br />Approved lar Construction <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersi9netl owner/applicant herehy agrees to hold and save harm- <br />less ihe Cily ol Everett Irom any and all claims lor damac�es, cosls. <br />eapenses, or causes ol action that may arise because ol inslallation <br />and maintenance ot th� improvement o� other righl-ol-way use hereto <br />applicd lor and lurther a9rees to remove same upon notice Iwm the <br />Date Cny and to replace pub6c properry dama9ed Ihereby. <br />FINAL INSPECTION Da�e <br />Approved as Constructed <br />����iq� PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evcrett, WA 99201 <br />Phone:259�8810 <br />urc ol Applicanl <br />Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED 6YITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PcRMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPA6E OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />� <br />