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Date ^'�/ <br />AOPlicallan Far <br />PUBILIC WORKS PERMIT <br />Print or Type Oniy <br />v„m.c wm�. r.�mn . ' .'\ <br />o.au u�o� . �J�'���SCY _ <br />���,<�.o,..... <br />,o,.��.� s— <br />i... �vo� r.n v.m S <br />mi.navo.e f <br />cl ��"%/ <br />� ��— <br />Fnonc <br />�lt%/l��-{�/% <br />Applitanl MnihnpAdtliess Ciiy Zip Phone <br />bescribc PmposeE Work �X'� ��%� ��`�" <br />Proiecl Aadress (il koown) <br />Attach lour �4� copies ol plans for proposatl woik � Draw lo scalo antl nota t�e IollowinB as appl,caple�. <br />• Proporry Lines • Cente�l�na ol street <br />• Omline and dimensions al oll ozisting antl • Intlicate Norlh <br />pmposetl sbuctwes on t�e IOI • Snow any nmoosetl pratling changes <br />• Evisling entl pr000sea utilities • S�ow measuremenls <br />PFRMIT CONDITIONS <br />I. all wlls br inspeclion shell be mode 2a nrs. in navanco � phone 259•A81 O. <br />2. All work shell be pedormed in nccordance with Ihis permi� end currenl City ol Evaro110esign �ntl ConSlmction <br />Slenderds and Specilicnllons. <br />e. Coll Lxnlion Untlerground Service 4B his belore you dig. TOLL FNEE NUMBEfl 1•800�424•5555. <br />TUl1lic uJvz�- /��o�....� /fio� r�' �:u.��a� <br />�-ac -9/ <br />�,,,;� �' <.�'� <br />/ PO�ovetl Inr ConslmCiion DatC <br />FINAL INSPECTION Date <br />App�oved as Constmc�etl <br />�PUBLICIVORKSDEPARTMENT <br />3200 Cednr Siree� <br />Everett W 4 9BY01 <br />Pnone:259�9810 <br />A�KNOWLEDGEMENT OF CONnITIONS <br />W <br />H <br />� <br />Z <br />O <br />� <br />��� <br />� <br />a <br />Tne unacrvgned owneUappliwnt here0y agrees lo hold and save harm <br />Iess iM1e Ctly ol Everell Irom any antl all claims lor Eamages, cosis. <br />CMpM5C5. Of Ld115C5 O� dCIlOO �Ildl T8Y .1115Q �CClU52 0� IOSIIII.lIi011 <br />antl maintenance of th? imVrovoment or ot�er uq�l�o4way use nerelo <br />opplietl tor and Iurl�er n9recs to renove snme u0on noLce Lom ihe <br />Cily anE to replaCe public proper�y damageA :hereby. <br />Signature al Ppplicant Dnte <br />WORK AUTIIORIZED �Y TMIS PERMIT MUST BE STARTEO \YITNIN <br />18� DAVF OF CAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUEO TO COMPLETION. TMIS PERMI7 IAAY BE <br />CANCELLED BY THE GTV UPON ANV STOPPAGE OF WORK ON TMIS <br />PFpJECT OVER PO DAVS DURATION. <br />