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��� <br />� <br />b � <br />C nq <br />N <br />K �H <br />T y b <br />� �i � <br />O �"I <br />��R�• <br />���F+ <br />N <br />M <br />O N <br />� �y trC <br />O y <br />N <br />� �� <br />� 'J. <br />Date �' - �� �i � <br />>pplication For <br />PUBLIC VNORKS PERMIT <br />Print or TypP Only <br />� i�,, _ ;, � :, <br />/;,.-;< ; � <br />`� i,i > , i�.>>.�,G� . . � � - a�r <br />„___. Mailing Atldress <br />i ��.� <br />��„i,i��_�v���.n�.�m,i. _�" — <br />Bltlp OeO� � - <br />PubhcWar4sFeo S <br />iola�fee <br />LCxSAppliP¢PA�JS " <br />�a11nCU Oua S �j � <br /><„�, � �._> � <br />�- ��z-,�z�- <br />,-'> > �'r' Phone <br />- Alailing Address ���Y Z'� <br />Applicant <br />/ j i , i <br />//% �� i� .: l � ' �—x=+'�+�'"��-' <br />Describe Proposed Work ! � <br />Projecl Address lif knownl ��' Yl� i` <br />Atlach four (�r copies ol plans for Proposed work � Draw �o scale antl note � Ce'terline ol SVe��c�ble�. <br />• ProperlY Lines � Indicale Norlh <br />• Oulline a��d dimensions of all existin9 antl � ghow any proposed graUinia changos <br />proposed 5lrucWres o� �he lol � Show measuremenis <br />• Ex�sting and p�oposed ulilit�es <br />1 PtRMITCONDITIONS <br />.�� 1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•b3i O. <br />� , 2. All work shall he pedormed in accordance with this permit and curreil Cily ol Everelt Design and Construction <br />� Standards and Specifications. <br />3. Call Location Unde�grounA Service 48 hrs. beluo you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �� <br />��1 <br />: ,__ <br />�._� <br />„ �,, „..a: :.. t„ <br />�/ �� ��, % t� G�• <,!�,,.- �1 �,- �-�-, �. / <br />� j <br />/�' /r�..� r:.�'t?� 1 ci7 �–/ %'. Cuf�offac/x�'. <br />� L' � rc /'� " �'/ ' <br />J ��r l���lOPinciYf 17r f�iJ P / <br />J. .- i:. Tli�n_ J. <br />� J<�l'� / !,!'�> .. 4 i�Cnc���iF�i�� . <br />,.�..,�>;z� „�„�� � <br />_� �:��.;�,,,..�:��-' J!�%'.' <br />pppmved for Conslfud�orf�i Date <br />'G'" <br />. /, <br />_��� �� (�i� ,f'� � 0 7 � <br />'t_ Dale <br />FI INSPECYION <br />Approvetl as Construrted <br />� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />� <br />�r Evcrelt. \NA 98201 <br />Phone..^.59�dR10 <br />Z <br />� <br />N <br />� <br />a <br />11CKNOWL[DGLM[NT OF GONOITIONS <br />The undersigned owner/apPlicant nere6y ag�ees tu hottl and save h.�.nn� <br />less the Gty ol Evnrett irom any and all claims tor damac�aa co;��s. <br />expenses. or causes of action Ihat may anse because of insL�ll,e�:,n <br />and maintenance o1 ihe improvemeM or other dphl-ol-way use hen•to <br />applieA lor and luriher a9rees lo �emove same upon notitc trom m�� <br />Ci�y and to renlace publiC p�aPe�ry damaged ihCreUy. <br />.�/ .% � J-`l'y/'� S� �/i L _ _ <br />-81�nalwe ol Applicant Ualc <br />WORK AUTHOf�IZED 0V THIS PGRMIT �dUST BE STARTGD WITHIN <br />180 D�YS OF DAT[ PE^MITIS�SSUED AND THEREAFTERIS TO <br />�E DILIGENTLY PURSUED TO COMPLETION. THIS PERM1UT MAV BE <br />CANG[LLED BY THE CITV UPON ANY STOPPAGE OF WORK ON 7HIS <br />PROJECT OVER 90 DAYS DURA'IGN. <br />