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y n i-+ <br />,.. r 'a <br />��H <br />C�H <br />9 H C/� <br />rx <br />r� > a <br />Kz� <br />H� <br />O 50 <br />'z]H=7 <br />V1 H <br />t�--� o m <br />H t7 <br />��g <br />�� � <br />a y� <br />rHy <br />8 �' <br />CC� b N <br />3 [G�] C" <br />�x-7 O l�n <br />Date '..���i�i . . <br />, � <br />Applicalion For <br />PUBLIC WORKS PE�MIT <br />Print or Type Only <br />7 <br />.l�,l i /l[ '� I/(/ <br />cny <br />auouc wo�ws aermn • <br />m�!n�enl.• 1%/ ��5���''� <br />� __ <br />r„m�c Wor�s �ce <br />�ciniFce $ <br />,. ,s aooi. �ee aa�a 5 <br />p—i•..��.eDur S __— <br />�C�ii� � — <br />Applicanl Mailing Add�ess City Zip Fhonc <br />/,f n <br />Descnbe Proposed Work �� ! + � ��-� L, ��' � � I �'���� `�� � � � � - <br />, <br />proieclAddressl�lknownl _ ��`',�'� �(% � :�'��tl��i ___ ______ <br />A�taU� lour i41 coPies ol Plans br P�oposed work - G�:r:. ;�, ,..� �. ;u,�; ��.r,te tne lollowing as appl�c.i', .. <br />• Propeny L�nes • Cente�lme ol ;Imet <br />• Outhne �nd dimensions o� [�II et:sl��ni .��'d • Indicate Norlh <br />proPosed 5trucWres on Rv, lof • Shaw any P�"i��:�^�1 nr,,�b�,q ��.i�..,ncu_. <br />• ExisLny dntl propoPeU uhLl�es • ShOw meas�..�emrn'r: <br />pp t.tl <br />PERMIT CON�ITIONS <br />1. All calls for inspec�ion shnll be matle 24 hrs. m advance - phone 259•8810. <br />�m �, 2 All work shall6e pedamed in actordance wdh t�is permit and current C�ty o� Ecerett D��:.�qn anA Conslruction <br />� � Stnndards and Speci�¢ation;. <br />3 Cn0 Locahnn Under ,ro;�nd Scrv�r�� .:R his 1�•-Ir�i.� �n,� d�q TOLL FREE NUMBER 1-8��-424-$rJ�JS. <br />�.� �.� <br />r'-:": <br />� <br />�; <br />,�'- .�� - <br />Z <br />O <br />H <br />� <br />� <br />, � - ,� f y,- . , ,.i` � . ,- �� � <br />/ ��^ �� �-.t � . ,a � ,� '". � ,. <br />�. <br />7, f r� f'.�� � �{ �� j �/� , . . � ,. : _. <br />�. �- ` � �«u'... <br />1� ,. C�,� , �rty L/��,�L S ACKNOWLEUGEMENTOFCONOITIONS <br />N'` '��t The unde�sig�ed owncr/appliwnt hercUy agrees to holtl and savc haim� <br />� less the Gly of Everetl liom any and all claims for damages. r,osls. <br />expenses. or causes ol aclion thnl may anse because ol installabo�+ <br />and malNenance of Ihe improvemenl or other n9hbol��vnY ��sr hi'roto <br />apP���'d for and lurther apree5 to remove samc upon nuhcr hom Ihc <br />Approvetl lor Constmc�ion ���� City and to �oPlace public pioperty Aamayed Ihereby. <br />FINAL INSPECTION <br />Approved as Constructed <br />evcu�❑ PUBLIC WORKS DEPARI ME�T <br />� J200 Cedar Strr.el <br />[vr.re�l, WA 98201 <br />Phone'. 25&8810 <br />Sipnalwc ol APPlicant Datc <br />WORK AUTHOF4ED BY iHIS PERMIT MUST BE STARTED WI7HIN <br />180 DAVS OF UATE PERMIT IS �SSUED AND THEREAFTER IS TO <br />BE DILIGEN7LY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br />CANCHLLED 6V THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OVER 30 DAYS DURATION. <br />