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yxC�H <br />Cjf M � <br />A�x <br />C, H <br />AHN <br />4 <br />y i�-+ <br />�C C) <br />H �1 <br />oxo <br />'i1 N �4 <br />(A H <br />y rg <br />� O l*1 <br />HC <br />OH <br />H�g <br />� V �] <br />zH�H <br />�HH <br />� <br />gd� <br />� � C�1 <br />zym <br />H O !1� <br />' �. <br />�� <br />oate�90 <br />ppplicaiion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Zip <br />Describe Pmposetl Work <br />Proiect Address lil knownl <br />PuLi�c wo�xa Pe�m�t • - <br />niae oep� . J l <br />PuolicwmAsfee 5 <br />iolai Fce <br />Lese AOPI Fee Pant 5 - <br />Baiance Due <br />sa-� <br />Altach lour (41 copies o� Plans for Pmposed work - Draw to scale and nole Ihe lollowin9 as applicable: <br />• Property Lines • Centedine ol slreel <br />• Outline and dimensions of all ezisting and • Intlicale Narlh <br />proposed stmcWres on Ihe lot • Show any proposetl gradine� changes <br />• Existint] and proposed uUldies • SI',ow measWements <br />PERMIT CONDITIONS <br />1. All Call5lor inSpeclion shall he matle 24 hrs, in advance- phone 2$9-88i�. <br />2. All work shall be pedormed in accortlance with ihis permit and current Ci�y ol Ereiett Desinn and Consiruction <br />Slandards and Specifications. <br />3. Call Location Underground Service d8 hrs. belore you dig. TOLL FREE NUMOER 1•800•424•5555. <br />�7,�r;'e lil" r , /f''n,; / /'%f /t�c:�,,,<� <br />Consiruction <br />�, �.-:�i-- <br />, -i-� -, - , <br />ACKNOWLLDG[MLNT Of CONOITIONS <br />LJJ <br />� <br />� / <br />Z <br />O <br />'�^ <br />V+ <br />O <br />a <br />The undersigned owner/app�icanl hereUy agrees to holtl and save harm� <br />less Ihe Gty of Everetl from any and all claims lor dama9es. costs. <br />expenses. or causes ol action Ihal may arise because of installation <br />and maiNenance ol the improvement or other righ4of�way use herclo <br />applied lor and �urther agrees b remove same upon notice Irom the <br />Date City and to replace puULc p�operty damagr.d Ihereby. <br />FINAL INSPECTION Date p��� — <br />ApproveA as Constructed Si�na�um of Applicant <br />� WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WI7HIIJ <br />' everett PUBUCWORKSDEPARTMEN7 180 DAYS OF DAIE PERAUT IS ISSUED AND TNEREAFTER IS TO <br />0 320oCedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY �E <br />Everett. WA 98201 CANCFLL[D BY THE CITY UPON ANY STOPPAGE OF WOHK ON � IiIS <br />Phone� 259�0810 PROJ[CT OVLF� `.70 DAYS DURATION. <br />