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b � � <br />y y r�n <br />4 <br />K n <br />H :�7 <br />o m o <br />Rj M � <br />N M <br />[�*J O � <br />H O <br />O N <br />z n o <br />M R1 O <br />c� • n <br />� y � <br />H �Z-! <br />C fn <br />J �+ <br />fI C N <br />� °a r <br />2 H t�i� <br />H O fp <br />pate�ld�C�"7 ' <br />� � � � qpPlicaticn ror <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />;_ :.:...�..,,.p,-q ] IJ Z <br />Hin� oeni . —�1—!/CJ'd'_7-.3J <br />v,�oi��wnrtsr., 5_ ' __ <br />.�,., F,.� <br />LescAnol FnnVail 5 --- <br />e�ia�r.�.o�� 5 _ <br />ng <br />qpplicant <br />Describe Proposed Wa�k <br />Proiect Address U� known) <br />cn,, <br />� I• nd note ihe following as apphcable. <br />Altach lour (41 copies o� P�ans lo� Proposetl worh � D�ew to sc.� t � �� C�nterline o� s�reet <br />• Property Lines • Indicale North <br />• Outline and dimensions of a�� existin9 and � Show any p��Posed 9<<�h���tl <h�°y�' <br />.- FroPosetl strucWres on Ihe lol � Show measurements <br />• Fxisting and pronosed utilities <br />PERMIT GONDITIONS <br />����. 1. All calls tor inspeclior shall be made 24 hrs. in advance � Phone 259•SB � <br />' �a 2. All work shall 6e pedormed in accordance with this permil and curreM City of Everett Design and Gonstruction <br />� Standards and Spacilications. <br />3. Call Location Underground Service 42 hrs. belore you dig. TOLL FREE NUMBEH 1•500-424•555 . <br />I r� <br />s„ � <br />%��l i �,c '-r���,,,� f-v <br />�/ ; , <br />` `, `��' -_ <br />�• -.; � - � •; <br />App�oved tor <br />FINAL INSPECTION <br />Apo�oved as Construcled <br />i,�i,���� PUBLICWORKSOEPAFTMENT <br />� 3200 CeEar Sireet <br />Everet6 WA 98201 <br />Phone�.259�8810 <br />Dale <br />W <br />� <br />O� <br />� <br />ACKNOWLEDGEMEM OF CONDITIONS <br />The undersigned owneVapPlicanl hercby agrees lo hold �nd sa�e hann� <br />less ihe Ciry of Everett irom any and all claims lor dama9es. costs. <br />expenses, o� causes of action Ihal may arise 6ecause ..f insta�l�dion <br />and mainlenance oi ihe improvemenl or olher righi�ol-way use hereto <br />applied tor and furlher a9�ees to re�nove same upon notice from the <br />City and lo replace public properiy d��maged �hereby. <br />Dale �`�` <br />Si9naWre of Applicant <br />BORDA STOFRDAT�E PERMIT ISEISSUED AND THEREAFTfiR ISF�TU <br />BE DILIGENTLY PURSUED T� COtdPLET10N. THIS PERMIT MAY BE <br />C�NCLLLFD BY TliF. GTY UPON ANY STOPPAGE OP WOFaK ON THIS <br />I'ROJ[CT OVER 30 DAVS DURATION. <br />