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�r� <br />ry� <br />D Rf x <br />q H <br />�H�n <br />y��-�i <br />�C C� <br />H �1 <br />A7 M �il <br />V7 H <br />[s7 O � <br />ON <br />/���g <br />y�V (] <br />aH� <br />Y <br />gHy <br />� <br />c� Cy V1 <br />z� � C�1 <br />HOp� <br />� �� <br />Date lo .=91 <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />permabilt <br />Describe Proposed Work <br />Pioicct Adtlress (il known) <br />i �tat <br />Address <br />16521 Iiwy 99 <br />Mailing Adtlress <br />�i �� � <br />- <br />,��.��_,�,:,,,���.�,,. _� -- <br />i,, �,.�, .. 91/28007 -- <br />���. �,•,o,�,«� 5 -- <br />roia�fen — <br />i.-� /�o� fee eam 5 <br />�Z� <br />e�,�.,�,�� o�� 5 a20 — <br />C°D� • �� '- <�c-, _ cx�0- //- �93i <br />CiIY Zip 1'none <br />Lynnwood 96037 743-1555 <br />City ZiP Phone <br />Atlach lour (41 copies of plans lor pwPosed work - Dra++ to sc�lc antl note it;e lollowing as applicable- <br />• Property Lines • Centeiline ol sVeet <br />• Outline and dimensions of a0 exisling and • Indir.ate Norih <br />proposed simctures on the lot • Show any proposetl 9inAin9 changes <br />• Ezisting and proposed utillties • Show measwement; <br />LINE <br />PERMIT GON�ITIONS <br />1. All call5lor mspeCtien Shall be made 24 hrs. in ativance- phone ZS9•BB�O. <br />2. All work shall be pedormed in actordance with Ihis permii and current City of Everett Desiyn aad Constiuction <br />Standards and Specif ications. c�• r <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL f REE NUMF3ER 1•800•424•5�.bJ. <br />. , <br />,� �u �< <r> .tL� � z � r. �/,� � <br />r/ �C�«„�����, �z,m<� <br />,. -� f - �� � � 1,�.! �i � !� /��r: ,.,f..: <br />/�.r � �� � ._ � +.�",�!' c « . �. <br />S�.,�., . - <br />u�:.� n,,t/.. -��;:�. b:,_„_;�=ry_ <br />Cr��� <br />!` � <br />r <br />.-�,C �i�r�— //—�—Y/ <br />AnProved for Con;l� clicn Dale <br />( � <br />'� - � �—.. � . �/ � L <br />� .�v <br />RNAL INSPECTION Date <br />qpproved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />,Vr�� 3200Codar5lreet <br />Everelt, WA 98201 <br />PhOne�..^59�BB10 <br />Z <br />� <br />ACKNOl1�LEDGftdLNT OF CONDITIONS <br />Tlre undersigned ownetinpplma�d heieUy a9rees to holA 2nd save haim� <br />less Ihe City ol Everelt liom any and all claims lor tlama9�s, cosis. <br />expenses, or causes ol action that may anse because of ins�allntion <br />and mainlenance ol Ihe improvement or other righl-of-way use hen�to <br />appiied lor and fmther agrees to �emove same upon nolice Irom Ihc <br />City antl to replace pu��ic property damayetl thereby. <br />Si{)na�ure ol Applicant ���`� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTfO WI1HiN <br />1d0 DAYS CF DA1E VERMITISISSUED AND THEREAFTEFIS 10 <br />BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT A1AY 9E <br />CANCELLLD BY THE CITY UPON ANY STOPPAGE OF WOFK ON iH15 <br />PROJECT OVER 90 D�1VS DURA110N. <br />