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��y� <br />A xl x <br />>HN <br />Y <br />1'� ii <br />H 7a <br />�fHpM <br />�O <br />� H d <br />H/��g <br />y�V C] <br />t"y� <br />gyy <br />c❑� C7 U� <br />[+4 �y i�l <br />HOfy/� <br />� <br />� <br />� <br />.�' <br />Date �� �>-/ � <br />qpplic�tion For <br />PUBLIC WORKS �ERMIT <br />Print or Type Only <br />Idailing <br />�1�� <br />�i%2 S .S�ti �wizS � / <br />Atltlress �'�Y <br />`' 3 c'� � ' <br />Puobcwo�kePe�m�l. � <br />nmq oeo� � <br />PuUbc Wo��.s Gee <br />ro,., F�e � e <br />Lrss Aoo� Fae PeN g �.L�/' � <br />$ �YY, <br />eaiaccn Duc __ <br />CC'Z' 3.i:' �10 /i.j/ <br />City up ��i���� <br />TA pP' � <br />DescriUe Proposed Work / '� �<<g ��a'J � "—/ ' '2G x S — � � <br />Proiect Address �il hnown) 7 Ft '� <br />Attach four �4) copies et plans �or proposetl worh - Draw lo scale and note� Cenllerline ol stpeet �ble: <br />• Properry Lines � �nAicate North <br />• Oulline antl dimensions ol all existing antl � ghow any proposed c7ratling changes <br />propoied siructures on the lot � Show measuremenls <br />• Exis�ing and piopoSCd ufili�ies <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance � 4hone 259•8810. <br />2 All work shall be pedormed in accordance with this permit ao i turrent Cily ol Evaretl Design and Consimction <br />Standards and Specilications. <br />3. Call Localion Undergrountl Service 48 hrs. belore you diq, TOLL FREE NUMBER 1•800•424•5555. <br />/ i <br />y. �ifi�/j[ lU ��c' �i'n2 noi q�nc�_;c� ���.:ii �� L�f)��l�t'.��. i <br />L i_ J .{ [ 1 ,�.� <br />�/ J,�7C i�l��/ �L�'nninq Ui^��/�, �Ui-)"f4[ / �.SlC'L:.' ��..' <br />✓ 1,�>,� <br /><<,�if�,� �.,�y ,�%;,�,�„� ���>r. af asi-,s�� � !;'.. <br />/�����,�- 1�'�i;. � � � V � n <br />I V , <br />� �ari i A �ss3 `—� <br />....... ............. <br />CITY OF EVERE'IT <br />F3uildin� Division <br />�%% �,l ����� /���9.� <br />Anproved lor Conslruction Date <br />FINAL INSP���� Date <br />l�pproved as Constructed <br />�Pl1BlICWORKoDEPAR7MENT <br />3200 Ced2r S�reet <br />[verelt, WA 9�207 <br />Phwe'. 259��G10 <br />r <br />ACKNOWLEDG[MENT OF CONDITIONS <br />The undersigned owneqapP�icant hereby. gre=s to hold and save harm� <br />Icss Ihe Ciiy of Everetl lrom any and all Uaims for damages. cosis <br />e.penses. or causes of action that may arise because ol inslallation <br />and mair.tenance ol Ihe improvement o� other ngh4of-way use hereto <br />apphed �or and lur�her agree5 to �emove same upo� nolice Irom the <br />City and to rep�ace public p�operty damaged ihereby. <br />l�,l�' �xvi2a L-��I Jv� c, ��l`��� <br />�gnaWre ol Applicant Datc <br />VJORK AUTIIORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAiE P[RMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGLNiLY PURSUED TO COMPLETION. THIS PERMIT MAY BG <br />CANCLLL[D 6Y THE CITY UPON ANY STOPPAGE OF WOi7K ON THIS <br />PFOJEGi OVLR 90 DAYS DURATION. <br />W <br />� <br />�w <br />_ / <br />� <br />O <br />� <br />� <br />O <br />a <br />