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�r� <br />� <br />m�x <br />C H <br />9H� <br />rx9 <br />y5H <br />�H� <br />� � � <br />�o� <br />OHd <br />H�g <br />(7Y (] <br />zyH� <br />L�yZ <br />h-i H <br />� <br />H <br />C'] C7 fn <br />� � Cs1 <br />ZH[n <br />HOfA <br />I �� <br />i <br />�'�� <br />__� <br />Date ' Z�Y <br />Application Foi <br />RUBLIC WORKS PERMtT <br />Prinl or Type Only <br />I <br />Mailmi� Adtlress <br />Z � J � �/h/�. /V <br />Uescri6e Proposed Work <br />c���, <br />Cily <br />z�� <br />��,,,,�:: �:,�,,.� �_.,,�,� 7 — - <br />oino o�ni • ��`��1� <br />aooi��wa�wsrce/5 _— <br />iolal Fec <br />Lr•��, P:::I I..r 1`e��f 5_-- -- <br />.. ,� ..i.i. S. ._. <br />�] /J/J�/�`�� ,/�,,���1 <br />Prolect Adtlress 1�1 known) � ��" � ��!��/1--t1-Y--�l-C�Lif �— — <br />Attach four 14) copies of plans lor propOsetl work - Draw to scalr, and note ihe follov+ing as applicable: <br />• Proper�y Lines • Centerline of stieet <br />• Outline antl dimensions ol all ezisting and O Indicatv Norlh <br />p�oposed strucWres on ihe lot • Sho�: a��y P�onosed 9ritlin� changes <br />• Existing and proposed utilities • Shov+ nieaciu�incnts <br />LIN[ <br />PERMIT CONDITIONS <br />t. nll ;,.,Ils for inspection shall be matle 24 hrs. in advance - phone 259•5810. <br />2. All work shall be pertormed in accordanee with ihis permit and current City ol Evereu Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you diy. TOLL FREE NUMBER 1-800•424-5555. <br />f���«� ���,,,������..�.t.�fn�.����fti,�;<<n <br />Approved for Construction <br />ti� �1��� �� <br />� <br />S_. -;�. <br />W <br />� <br />�'� <br />� <br />Z <br />O <br />� <br />� <br />� <br />a <br />ncr:rao�v��o��ra�ur or ccNoirioNs <br />The undeisi9netl owner/aFPlican� hereby a9ree5 ie holA anJ �.,a�e h.nm� <br />� luss ihe Giiy ot Everetl Irom . ny and all claims loi dama�p^;. � os1=; <br />expenses, o� enuses of aclion Ihal mny arise hecmiso ol mst�ll,,tion <br />nnd inainlenance ol lhe improvemenl or oiher nqhbol-�vuv �u�� ho���to <br />appLed lor and lu�iher a9rces to remove samc u[�on ���'i�.�.�' i�<^n tn^ <br />Oate Cily and Iu repiace P�bhc proper�y damaged ihereby <br />FINAL INSPECTION ���� <br />ApP�oved as Constructed <br />evcr�tl PUBLIC WORKS D[PAR7MENT <br />� 3200 Cedar Slrect <br />[verett WA 98201 <br />Phnnc� 259�8l310 <br />SiqnaWre ol APplicant ��i�° <br />WORK AUTHORIZED BY 1H15 PERMIT MUST BE START[D WITHIN <br />180 DAYS OF DATF PERMIT IS ISSU[D AND THEREAFT[R IS TO <br />BE DILIGENTLY PURSUED TO C��61PI P71ON. THIS P6RC11T I.tAY BL <br />GANC[LLED BV THE CITY UPON nNP S�IOPPAGC �)F \Y(�N�� i=N � ili5 <br />P(70JEGT (1VER 90 DAV.S" pURA7l� �tJ <br />