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���0 <br />[4 � <br />� � <br />��� <br />��� <br />��o� <br />HG <br />ppA <br />� M�� <br />V� <br />aH <br />W ��" <br />OW <br />_, <br />DBl@ ��%� i�iJ �-' <br />npplicalicn For <br />PUBLIC WORKS PERMIT <br />Print or T��pe Only <br />i�t��.la� ,I l�'�" ��� <br />Ownei Mading AAdress <br />i <br />- qpp icant Mailin9 AAtlress <br />/ <br />Describe PropOsed Work ' <br />Cit; <br />r=„o��cnvm�e re, i • ��vj/)? � - � <br />r�i�� o.•ni . ���`-� `�-1_�_ _ <br />PYI�IiC \Y01A9 in[ �_ <br />rcmirPn 5 -� ' <br />«„ <��,� , �„ ��.. , � � z- <br />�.,..,,,: �. ��,. 5 ,� z '- _- <br />prolect Address lil knownl 'S'�"30— s Z h dAvE ----- <br />Attxh lour I�) �op�er o� plans lar P�oposr.d work - Draw to sr,ale antl no'e the bllowing ns applicahle� <br />• Prop<<�Y Lines • Centedme ol ;ireel <br />• Out4ne and tl:mensans ol all existirg antl • intlic.de Norlh <br />pr�poseU sbuclures on Ibe lol • Show any proposed gratlicg changes <br />• ShOW mCflSurE?mCNs <br />• Cxisbng and proPosed ulihtie5 <br />� PERMIT CONDITIONS <br />t. AII calls for insvection sha11 be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pedormed in accordance with this permit and wrrent City of EverMt Desiyr and GonsVuction <br />Standards and Specilications. <br />3. Call location Underground Service 4� hrs. belore you dig. TOLL FREE NUMBER 1•800•4?.4•5555. <br />,/ � � ��_/- .� -.3-�`) <br />� <br />T � �'/ �/' , •�„^..i � /�7/Ct vti-� c: C: <br />,t i � <br />/ , / <br />Y' / � <br />���-�— �_s_ <br />ApProved as Constructed <br />cverclt PUBLICWORKS�EPARTMENT <br />� 3200Cetlar5lreet <br />Everetl. WA 98201 <br />Phane�.259-BB10 <br />Date <br />, <br />W <br />H <br />�w <br />_ I <br />z <br />O <br />�w <br />� / <br />O <br />a <br />�CKNO�M1'LEDGEMENT OF COtJDITIONS <br />The undersi9ned ownerlapPlicant hereby a9rees lo holtl anA save harm� <br />less the Cdy o� Everett �rom any and all claims lor damages. costs. <br />expenses, or causes ol aC�ion I�•.al may anse because ot inslallation <br />and mainlenancc ol Ihe mip�ovemenl or other ric�hPof�waY use hereto <br />apphed �or and Imiher agrees to remove same upan notme Irom Ihe <br />Cily ancl to replace puUhc propmry damayeA Iherr,Cy. <br />���� � ,�� �- �- y� <br />Si9nnlme o� ApP����n� Date <br />WORK AUTHORIZED BY THIS PEFiM1T MUST B[ START[D WITHIN <br />180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NiLY PU�7SUED TO COMPLETIOfJ. THIS PERAIIT MAY BE <br />CANCELIED BY THE GTY UPON ANY L?TOPPAGE OF WORK ON THIS <br />PROJECT OVER �JO DAYS DURATICN. <br />