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��� <br />v�x <br />�H� <br />H�� <br />�pH� <br />'i1 H 'i1 <br />VJ H <br />�O�H <br />H�g <br />� Y (] <br />t"yZ <br />t-r y <br />y <br />C] C7 CA <br />� � C�1 <br />HOfyi� <br />i <br />._ _ _. ._. _ _ . _ . , _ .. <br />i <br />, L. <br />Date �� �� �� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />.; .� <br />�L Li. %lI.L Cr!if:�t.: �.�. �: ; , ' ����_' • C�r. <br />n....,.,. Mailina Atldress <br />/ � y' / <br />y' r, c c.. ;i.f`�-, � r.�; i;; :, :� ,:. <br />. ._�.___. ne��u�� n�d�.,<d <br />� �-� r„ni,� wo,ws ve�mn • <br />nmo oeni . �c� �J_ %�!'r <br />PuoucWoiksFee S <br />iOITI FCe <br />Less Aoo� �pa Pai� $ <br />oaiance0uc 5 <br />,�/.. � . L �.� '��.� �f �:.:_��.�t�:. <br />i 7_in � V Phone <br />� `;. �"'; i:1�;:,,;�; ;'%C'�rU �>�.—i `c/ <br />Cilv 2io Phone <br />Descrihe ProPosed Work , ,i .. %( ���`% ( ��r !i l �-1 /[. i . , . � ��� .' •'1 . <br />Proiecl Address lil knownl '( ��T ' � �� /� ' � l � — <br />Attach low 141 copies oi plans for proposeA woik - Draw to scale antl note ihe lollowin9 as apphwble: <br />• ProOerty Linrs • Cenlcrline Of slreel <br />• Outline and tlimensions ol all ex,stm9 anA • Indicate North <br />pioposed structures on Ihe lot t Show any n�oposed graAin9 U�an9es <br />• LxiS��n(J dllf� pf0(losed ldlli�iCs • SIIOW InedSulCnleni5 <br />F BE <br />PERIdIT CONDITIONS <br />7. All calis for inspection shall be matle 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permi� and current City ol Everei� Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Untlerground Service 48 hrs 6elore you dig. TOLL FREE NUMBER 1•800•424•5555. ' <br />�, , ,. <br />.�;,�,:; � r_,:--,� � ��-: - �t .. , , � -, � <br />�: <br />� <br />�I Approved for Conslruction Da�c <br />I� FINAL INSPFCTION Date <br />Appraved as' Constructed <br />! �.�i.��.p PU�LIC WORKS DEPARTIdENT <br />I � 320G Cedar Streel <br />@verelt. WA 98201 <br />Phone: 259-8�10 <br />ACKNOWLEDGEMEIJT OF CONDITIONS <br />The undersi9ned mvneVapplicant he�eUy ag�ees lo hold and save ha�•m <br />less ihe City ol Everet� Irom any and all claims lor dama9es, co=_is. <br />expenses, or causes ol aclion lhai inay arise because of ins�allatio�� <br />and maintenance ol the improvement or other ri�hPot�way use heiato <br />applied lor and lurther agmes �o remove same upon notice trom the <br />City and to replace public pwperty damaged lhereby. <br />Signature ol Apphcant �`��'' <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIPJ <br />1B0 DAVS OF DATE PER�d1T IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSULD TO COtdPLETION. THIS PEFMIT MAV 6E <br />CANCELLED �V TN[ GITY UPON AIJY STOPPAGE OF WORK ON THIS <br />PROJI?GT OVER 90 DAVS DUHATION.— -- J <br />