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x�+� <br />HO <br />lT. C+7 <br />G�H <br />9HCn <br />4 <br />H � <br />Ox0 <br />"s] H "i1 <br />(n �-I <br />H <br />�H�G <br />O H <br />H�g <br />�1] V �q] <br />SHLTI <br />t'�HH <br />O�H <br />C] C7 fn <br />��M <br />H O cn <br />i�_._J_��.� � <br />Date_— � � <br />Applir.a�icn Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />i <br />—' ���'1�"—� 1 � �� <br />oe:, ei " ( <br />�pphCan� <br />Descnbe?rOp05edWork _ <br />ny �tlUress <br />Maihng <br />Piolect Addresslif hnown) �, <br />ur>' <br />c��y <br />ID <br />z�n <br />; .,•. �;.. ... � ., . , ; .! ! �L,c J .�. <br />eu,,., .�ru� . '_�`i= _(_ `Z �� <br />Fubl¢\Vmwnfee 5 <br />toiaiFr�• <br />i..�>n:i i... r.�.� s---- - <br />�.�.�.....i�,.. 5- __ _____—_ <br />Attach lour (4) copies ol plan5 �or proPOsed •++ork � Draw to cc>I� and note Ihe tollowing as aPPlicable. <br />• Property Lines • Cenlerline of slreet <br />• Outline and tlimensio�s o� all exis�u�9 and • Indicate Norih <br />propasetl s:ruciures on ihe �ot • Show inq proposeA 9r.iUmc7 changes <br />• ExiSUng and proposed utilitie5 • Show meavrtemenis <br />Phone <br />PERh11T CONDITIONS <br />1. All c2115 tor inspcction shall be made 24 hrs. in aavance � phnne 259•8810. <br />2. All work shall be perlo�^�ed in acmrdance wdh Ihis permit and current City ol Everett Design and Conslruction <br />Slandards and Sp^cihcations. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUh78ER 1•S00•424•5555. <br />�'� � / <br />��.a;itc j ��c'�� <br />/ lt - <br />Construclion <br />i`-a` -^` / �� <br />�? �. -4. <br />,%��� / <br />,/ -� ; �. <br />7—, --�y <br />1� <br />• <br />�u <br />i1CKNOVJLGUGEtdENT OF CONDITIONS <br />The unde�si�nutl owner/nUPhcani hereby aq�ecs �o hold and 5ave harm- <br />---; Iess ;hc City o� Eve�et� Irom any and ail claims tor tlamac�es. r,osl:: <br />ezpe�':e'.�„ o� causes ol �chon Ihat may aricp Uecause D� inslNlahon <br />anA mo�nlenance ol Ihe nnprovemenl or olher nghl-ol�way usi' hwcln <br />apphed �or and �urther a9rees to iemove same unon nobce �win the' <br />Dale Gty and to replace publ�c pwne�ty dama9ed thereby. <br />PINAL INSPECTION Date <br />Approvetl as ConsUucted <br />�.��i,�iq� PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evere��. WA 98201 <br />Phone: 259�E3810 <br />Signature ol APPlicant U`��`• —� <br />WORK AUTHORIZ[D �Y THIS PGRMIT MUST BE STARTED WITF{IfJ <br />180 DAVS OF DATE PFRMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DIUGLNTLY PURSUGD TO COMPLETION. THIS P[R��IT 1.1AY PE <br />CANC[LLEU BY THE CITY UPON �NY STOf'PAGL- OF \VORI< O^ i11i5 <br />PROJ[CT OV[� `-�0 DAYS DUFATION. <br />