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�1 C�7 � <br />9H <br />k> xl S <br />� H <br />9 H tn <br />H �� <br />�C C] <br />H 71 <br />"�� N '9 <br />Cn H <br />H tg" <br />� O lTl <br />OHd <br />H C��J O <br />�� nq <br />z H [�7 <br />� ht H <br />g�' <br />H <br />CC7, C7 fn <br />C�] � [r+7 <br />HOt�i� <br />�.; � ; <br />. „,. <br />B ' j <br />,. ,_i� , � <br />Dale—'-�_— � . <br />qpplicaticn Fr,r <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�- ��.`��-i . � �l� �� � , �`-�� �.� �� Z��"��i �--�� .G�� <br />Ownei Mmrm;; �Adress <br />Apphcant <br />MaBmg <br />� <br />Gty <br />Lp <br />,..,.��o,.sa.,,m,� �;' -� <br />v <br />.�,,�.i oeoi • .��_.��'>1_��� <br />� ��we��svre S —.__._'. <br />,:,',� �� F�e <br />u ss n.�,i v�e vmo 3 <br />(`(� — <br />r.��., ��.o�� S � _-- <br />����� - ������ <br />Phone <br />i /� � ��' <br />Desrnbc ProposeA Work ������ - <br />Prolect Adtlress UI knownl <br />Attach lo�u �4� cop�es of plans lor proposed work � G�nr; tu sc,d�, and r.nt�e Ine lollowing as applicabie. <br />• Propr.riy Lines • Centerline ot st�eet <br />• Oui6ne and dimensions of all erisiing antl • Ind�cate Norih <br />propasetl siruclures on Ihe �ot • Show any proposed grading ch:anyes <br />•[xistmy and proposed utilities • Show mezsuremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone :.'59•8810. <br />2. All work shall be pertormed m accordance wilh this permit and wrrent City ol Everett Design anA Construction <br />Standards and Specilications. <br />3. Call Localion Underground Service 48 hrs. helore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />:,�, ;,,, , ./ _ <br />.. �/1>eL��ia��.�7r �...! �^: ��.:�:. iJ�a..C<T.;.. <br />( <br />��" 7�c . 'r� -.��J <br />����-, <br />N,', 5` `�� ����� <br />"�JR�" <br />' (��,::.�.� ,t!! .j. �[ .�,. <br />:�� ��,�,�/��- <br />, �t���H°`'`""� � <br />/.�e/�� �o. --r <br />� �� �,zL��� <br />' �i; ;���� �<<<<i'�.� .j i- ,yy <br />Approved br Construction Dale <br />fINAL WSPECTION <br />Approvetl as Constiucled <br />rcrrrn PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />Evcrett, WA 9R201 <br />Phonc 259�OE310 <br />Date <br />W <br />� <br />� <br />N <br />� ! <br />O r <br />� <br />Z <br />O ' <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owncUapPlicant hereUy a9rees lo hold and save harm� <br />Iess �he Gty ol Everetl Irom any antl all claims lor damac�es. r.osts. <br />exUenses. or causes o� action that may anse Cccause ol installalion <br />and maintenance ol Ihe improvemenl or other nghl�of�waY :•se hereto <br />appheA 1or and furihm a�ree5 lo remove SamP upOn notice fiom ihe <br />C�ty and b replace pubhc prepeity damaged thereby. <br />a � �� <br />-���i�TL:: /� � �l-��%� �'-A i r'_ <br />Si nature ol ApPhcant / Dale <br />WORK AUTIiORIZE� BY�TIIIS PERMIT MUST 0[ STARTED WITHIfJ <br />180 DAVS OP C'ATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br />B[ DILIG[NTLV PURSUED TO COMPLETION. THIS PER�UT h1AY BE <br />CANCELL[D 6Y THE GTY UPON ANY STOPPACd[ OF WORK ON THIS <br />PNOJECT OVER 90 DA�S DU�7�110N. <br />