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[�f � � <br />O � x <br />�Hx[~i� <br />yxH <br />�H� <br />"�-0 H 'i1 <br />f/� H <br />[�70� <br />Hl7 <br />O I-i <br />��g <br />�j] V C(7 <br />� H [�1 <br />r� y <br />N <br />gd� <br />� � I�7 <br />zym <br />HOtn <br />�'�1 <br />��� ��� <br />Date�_� _ <br />M)pLcahcn f oi <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />l� �. i�'1 j �' l�i I�� �•. �_ <br />Ownei <br />qpplicant <br />MaJmy AAdress <br />AtlAress <br />1'..nii: \�lOr45 P�.rn�.l —Y ' .�� _ <br />l �' <br />c���.� orn� • —..�__�_ ____�_ ! � ' <br />PaLlicKor�xfce 5 <br />TOITI�1!e <br />L�SSApt�l fnppapl J <br />en�,�=„ n�� 5 <br />cny <br />GI� Lp Phane <br />/ / � 1 <br />Descnbc ProPosed lVork � �/ � 1 �C�-l� r�'� /� �- ---- ------- - <br />Prolec� Address lil knownl <br />Al�a[h lour 14� copms o� plans lor prOpoSr.A worh � Draw to 5caln a�d note Ihe tollowing as apP�ica6le <br />• Property Lines • Centedme o� 5'rect <br />• Outhne and tlimensions ol all exist�ng antl • Intlicale Norih <br />proposetl slructures on the �ot • Show any proposeA graAing chan9es <br />• Exishn9 and proposed utildies • Shn.v mcasurements <br />PERMIT CONDITIONS <br />t. All calls lor inspection shall be made 24 hrs. ia advance- phone 259•8810. <br />2. All work shall be pedormed in accordance with this permil and current City of Everett Desic�n and Constmction <br />Standards and Specifications. <br />3. Call Location Under9round Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />ApprovCA lor Conslruciion <br />T� l <br />� �_.•. I. �- ��.� �, <br />i , <br />� <br />.- � /, � .r, -�,-,i- _ <br />�C � <br />n <br />i'-//- :,' <br />W <br />� <br />� <br />� <br />O <br />�w <br />_ / <br />� <br />a <br />�CKNOWLEDG[MENT OF CONDITIONS <br />The untlr.r5��9ned ov:nei/ipplicanl heieby agrees to hold antl save hmnr <br />I less the Ciiy ol Everelt irom any and all claims lor oama9os. cosis. <br />— I enpenses, or causes ol aclion Ihat may anse because ol installation <br />and mimtenance of the improvemenl or other nghbobway use hereto <br />applietl tor and luriher a9rces lo remove same upon nolice Iwm Ihc <br />Uate City and to replace puUhc property damaged thereby. <br />fINAL INSPECTION Date <br />Approved as Cons�rucied <br />evo�rll PUBLICWORKSDEPARTh1ENT <br />� 3200 Cedar Sireet <br />Evereli. WA 99201 <br />Phone: 259�8810 <br />Si�nature ol ApphCaM ���� <br />WORK AUTNORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br />9E DILIG[NTLY PURSUED TO COMPLETION. THIS PERM1IIT MAV 8[ <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF W0f7K ON THIS <br />PROJECT OVflR 90 DAVS �URATION. <br />