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� Cs1 � <br />9 �-3 <br />��H <br />a�x3cn <br />y x r�-+ <br />�C C) <br />H X1 <br />o xo <br />'� H "i1 <br />(A H <br />xp <br />H <br />OHd <br />H�8 <br />L� � C] <br />�H� <br />yy <br />8 H <br />c� C7 N <br />��� <br />HOy <br />��' 1 <br />1 � <br />� � 1 <br />�;� <br />� � � <br />�T��Date_-' " <br />Application Fei <br />ryUBLIC WORKS PERMIT <br />Print or TyUe Only <br />Maihng <br />Describe Proposed Wark <br />Project Aduress Id known) <br />i.ny <br />City <br />Zip <br />Put�l¢ War49 Per �1 . � <br />r <br />omq oco�� • — <br />v„ei�� wons rce <br />tm.iv�� S <br />�i•ss n��n r�� r�.�m S — <br />e.,�,���• o�� 5 <br />Attach lour (4) copies o� plans br proposed work - Draw to scale and note ihe lollowing as apPliwble�. <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions ol all exisling and • Indicate Norih <br />proposed struc�ures on (he lol • Show any proposed gratlmg changes <br />• Existir.g and propos�d utilities • St�ow measummenfs <br />rnonr <br />Phone <br />_ W <br />� <br />�w <br />_ / <br />PERMIT CONDITIONS <br />1. All calls lor inspectio� shall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be pedormed in accordance with Ihis permit and current City of Everett Design and Cons�ruclion <br />Standards and Snecifica;ions. <br />3. Call Location Undergwund Service 48 hrs. bebre you dig. TOLL FREE NIIMBER 1•800•424•5555. <br />���I 2�"CN111 N���� Izc_ GL <br />1�ck.��C Iti1����. <br />L- ��Z- /�J C <br />Approved lor Consiruclion Dale <br />FINAL IN£PECTION <br />Approved as ConsVuctetl <br />evercll PUBL�C WORKS �EPARTMENT <br />� 3200 Cedar Sireet <br />Evereil, WA 98201 <br />Phone�. 259�d810 <br />� <br />O <br />f• � <br />V� <br />0 <br />a <br />ACKNOWLEDGE6IENT OF CONDITIONS <br />ihe undersi9ned owner/app��canl hereby agrecs to hold and save harm� <br />Iess Ihe C�ty ol Evere�t fwm any and all claims lor tlam2ges. costs. <br />eKpenses, or causes ol aclion tha� may arise because ol installation <br />and mainlenance of ihe improvemenl or oihe� righPobway use herelo <br />3pplied lor and Iurlher ac�iees to iemove same upon notice from the <br />Cily and to replace pubLc property AamayeA �hereUy. <br />Signatme ul Applicanl Catc <br />WORK AUTHORIZED BV THIS PERMIT MUST OE STARTED WITHIN <br />160 DAYS OF DA7E PERMIT IS ISSU[D AND THEREAPTEF7 IS TO <br />B[ DILIGENTLY PURSUED TO COMPL[TION. THIS PEPMIT M11AY BG <br />CnNC[LLLD BY TH@ CIiV UPON ANV STOPPAGE OF WORK ON THIS <br />PHUJLCT OVEH 90 UAVS OURATION <br />