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�r�y�a <br />b ry7 m <br />� H N <br />K � n <br />�'] � <br />O W O <br />�q M h1 <br />V1 M <br />� H � <br />O H <br />��R <br />�• p <br />� H � <br />t� <br />H H <br />O y H <br />n a N <br />� � � <br />H O fNp <br />/... <br />I �_~''i <br />� <br />' o� <br />Date � "-' � <br />qpplicalion Fo' <br />PUBLIC WORKS PERMIT <br />Prinl or Type Only <br />r� <br />rubxcWo�MSPm`ryn��gy—�'�,' o <br />Ol�fp De01 • .=—I--�_�� <br />v�ni��wonsrc� S <br />IOIN:re <br />Less �nnl Fre PaiO S <br />polance pue w5 <br />nt <br />Descri6c Prcposed Work ��--`�'� - � <br />Proiect Address (if Mnownl <br />L1�1 <br />Attach lour (4) r.op�es oi plans lo�. ProPosed work - Draw to scale antl no�e� Ceoterline ol slPeei; able�. <br />• Property Lines • Indicate North <br />• Outline and dimensions o� all existing and � Show any �iroposed gmding changes <br />proposed 5trucWres on the lol � Show measurements <br />• Existiny and proposed utilities <br />- - ��J `�J <br />PEBMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permil and current City ol Everetl Design and Conslruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•55 . <br />�dt �°) . <br />qpproved for ConStruc�ian Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everetl PUBUC WORKS DEPARTMENT <br />� 32G0 Cedar Street <br />Everett, WA 99201 <br />Phone:259-8810 <br />� ��'/�� %�CC!"% <br />� ./,=5't�% <br />� <br />� <br />Ow <br />M / <br />i� <br />� <br />ACKNOWLEDGEME'IT 0�= CONDITIONS <br />The �ndersigned owner/appl�caN heie'+y agrees to hold and sa•:e haim- <br />less ihe Cily ol Everett Irom any anc all claims for aamages. cosis. <br />ezUenses, or causes ol aclion thal may arise because of installaliun <br />and ma�ntenance ol the imprcvemenl or other right-of�way use hereto <br />applied lor and turther a9•ees tc remove same upon nolice irom the <br />Cily and to replace public p�oPerty domaged thereby. <br />Si�nalure of App�iCant ---- <br />80RDAY`S OFRDAT�E PEFMIT ISEISSUED ANDBTHEHF F1DER I`Hrn <br />BE DILIGENTLY PUR::UED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />