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o � <br />Date � 3 S <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Prini or Type Onty <br />Pu01¢ Wp:b Po�mlt � <br />Oldp Dapt. � _ <br />PuOhc Wodf Foc S <br />Totel Fea <br />// � <br />Lase AO�L Fea Pnitl 5_ <br />Dalamv llua <br />� I l"1'1 �/G '1ar ��� �%'� J�h f�i+ �c/[I j �'-f - Y7�� <br />[% Applicant Mading ddress Cily Zip Phone � <br />Doscriba Proposod Work <br />ProjectAddres.;l�lknown, .�.��i�s r�`'�r.��' i�J�— <br />Altach loiu �4) copies oi plaus lor proposetl work � Draw to scate and note the followin� a; applicabte: <br />• Properly Lines <br />• Oulline and dimensions ol all eristing and <br />proposed 5iructures on the lot <br />• Eaistin{7 and proposed utilities <br />• Centerline ol street <br />• Indicate Norih <br />• Show any proposed 9rad u chan9es <br />• Show mea5wements <br />PERh11T CJNDITIONS <br />t. All call�: lor inspection shall ue made 24 hrs. :�n advance � phone 259•881 5. T— <br />2. All worK shall be poriormeU in nccordance with this permit and current City ol Everetl Dr-= ign and Construction <br />Stnndards and Specilicalionc. <br />3. Call Locnlicn Underground Servir.e n� hrs before you di9. TOLL FREE NUMBER 1•800•424•5555. <br />___ �/�i <br />�� � /! � ��—caZ3?�� <br />np iovod lor Con•.buUr� . / Dnto <br />��'' ,z�'��i'.--� -�-o - 6�6 <br />Y�!!.1 IIJSPf (; I IO�J n��� <br />APId„vrd n•� fJum��hu�lrJ <br />(�.,,•r�•❑\I PULILIC WOHKS DLPAI7TMLN7 <br />� :7np G!dnr Slr�ot <br />� i v�•rnil. WA 0!I?01 <br />� I'b„n�� �Of�•tib <br />ACKNOWLGOGLM[NT O� CONDITIONS <br />W <br />� <br />�/ <br />� <br />O <br />■ <br />N <br />O <br />a <br />iho undorsi9ned owner/Upplicont hereby aproos to hold and sava harnr <br />loss Ihc City ol Evorclt Irom nny ond all clnims lor dmm�aos, coxtc. <br />OMrQOSCS. Of C:WSCS 0� nclion that mny nrise hCG:11190 O� inslnllnfOfl <br />nnd mniNennnce o� the unprovnmenl or olhor �iphbobwny use I�.ornto <br />�nni�ad ior .111d IIIf�hOf a9ioe• �o iomovo snme upon i101�Cc IfOm IhU <br />CitY �nd to on �cr� U��6lic a rlv dnm�0ad IhorebY. <br />` �(���'r1k_ J <br />� <br />fi na�ure ol Appli �m� U�tlo <br />WO(7K AUTIIORIZFfI �Y THIS r EfiMli MUST [iE STAHIED WITIIItJ <br />100 DAYS OF DATG PERMIT IS ISSUf:D ANU TNLFiLAFTEiI �5 f0 <br />�[ DILIGCNTI.Y PURSUtiD TG COtdPI.EfION. THIB PERMIT PdAY H[ <br />CI�PJ(;f-LLCD PYIIII: CITV UPON AIJV ;fOPPAG[ �)6 WOHIc OIJ TH�:'� <br />1'Hf� II �'I f1Vf.l�'i0 hq'i'� 1)IIRn111��J <br />z <br />0 <br />H <br />� <br />n <br />m <br />—� T <br />H N <br />N S <br />0 <br />m <br />co <br />mo <br />n <br />1c <br />o� <br />.� _ <br />m -" <br />., <br />c= <br />�i <br />1 N <br />< <br />T <br />�p <br />�R <br />2 <br />m .- <br />� <br />r <br />r� <br />c v+ <br />� � <br />z �, <br />-� r <br />m <br />a <br />� <br />