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��� <br />A � x <br />>H� <br />y <br />1'C � ii <br />H� <br />�(~AH <br />�7p. <br />HC7 <br />OH <br />��8 <br />�Y �] <br />t�y� <br />HH <br />N <br />g�� <br />�H[�i� <br />.3ow <br />� <br />� <br />C� <br />�_� <br />Date ' � QU <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� L <br />ilin9 <br />ZG <br />Zm <br />i°�nu.vr.��t^�pi���i. _ �- <br />umn orn� • —/_(���-%J—�`-�—'- <br />Pu���cWo�hsfeo 5 � <br />ro,a, Fe� <br />�oss nooi Fc� ra�a 5 <br />oaw�r.co�P 5 _ <br />-711v2 <br />LDl �� Zr7l� — l Z J% <br />CiIY Zip Phone <br />DeScriUe Pruposed Wo�k �/�-�' ���P�� �a 1�������L{ <br />Prolec�Addiesslifhnown) -�-V.1--� <br />Atlach lour �4) copies of Plans br Pwposed work - Draw Io scale and note� Ce�nl�eiline ol tPee� able� <br />• Properly Lines � Indicale Norih <br />• Oulline and dimensions of all exislin9 antl � Show any proPosed yratling changes <br />proposetl siruclmes on ihe lol � Show measuremeNs <br />• Existing a�id P�oposed uhliUes <br />PERMITCON�ITIONS <br />t, All calls for inspection shall be made 24 hrs. in advance - Uhone 259•8810. <br />2. All work shall be pedormed in a[tordance wdh ihis permit and current City ol Everett Design and Construc�ion <br />Standards and Specifications. <br />3. Call Location UndergmunA Service 48 hrs belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� � / <br />�'[.i/):l''_c tc��,a�::_Itt`7�,,.cr �t�'T �i'�.ctit� •t' <br />App�ovoA for Consliuciion <br />FWAL WSPEC110N <br />Appioved as Coa Iruc�ed <br />i�,�,�iq� PU6LICVJORKSDEPARTM1IENT <br />� 3200 Cedar Sireet <br />Everelt. WA 98201 <br />Phone: 259�d810 <br />�i���� � �_ <br />. z -z v -i�, <br />ACkNOWLEDGGM1IEN7 CP CO�DITIONS <br />W <br />� <br />� <br />� <br />Z <br />O <br />The undetsi9i�otl ownci/appfieant he�ehy a9rece lo hold anri savo harnr <br />less Ihe City ol Everelt imm any and all daims for dama9es. costs, <br />expenses. or causes ol aclion Ihat may anse because of inslalla:ion <br />and maintenance ol the improvement or o�her righDof�way use hereto <br />applieA lor and turihcr agrees to remove same unon notice Irom �he <br />Cily antl �o replace puUlir, praperty damaycA thereby. <br />Dale Datc <br />Signalure of APplicant <br />WORK AUTHOFIZED BV THIS PERPdIi MUSi BE STARTED WIiHIM <br />180 DAYS OF DATE PERMIT IS ISSUED AND THFREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS P6Rh1R M�v BE <br />CANCELLED BY iH[ CITY UPON ANY STOPPAG[ OF WORK ON THIS <br />P�=UJLCT OVER 30I)AYS DURATION. <br />