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��� <br />ay <br />,a��x <br />ayx� <br />H z� <br />�e c� <br />H �1 <br />"�,1' H'TJ <br />V7 H <br />yx tg'' <br />tj] O l'�f <br />H l7 <br />H [��+7 O <br />�V � <br />rHH <br />gy <br />�d� <br />��� <br />z y �n <br />H O fn <br />Date �_�.�:�` I <br />AOp�iCalicn For <br />F�UBLlC WORKS PERMIT <br />Print or Type Only <br />n <br />� <br />I <br />� - � n,,:,�,�. vro,�s m�jjj.���.�j}( <br />E���I�1 Dr�PI a � ' __���L� <br />-------___ <br />PULM1r_ V:CM1S FeB <br />101�ll Fr�� S _ — <br />4�S l.:t{11 inr {�li� 5 _. <br />, _ . ,,.. s - --- <br />cip <br />In bl <br />ApphcaM t.ladmg Addrass City Zip Fhone <br />Uescrbe Proposad Work <br />Protect Adtlress Id knownl <br />AttaCh fOur !ai eopies ol plans lor proposetl c.or4 - Dr,i,;; i�, tir�ln ,ind nr,lr; tne �ollo�.ving as ap^licr�bh� <br />• Proprriy LineS • Crn�crlme C' Stiee� <br />• Outhno and dimensions ol ;,li �.nhn�� ,��, . • InUir,rte North <br />prOpo5ecl structures un ihr. Int • Show any propoSeA gr�dinr, chanye; <br />• En5hn9 and prOnosCtl uldiho5 • Shpw mCaSurentent5 <br />THIS LINE <br />PERMIT CONDITIONS <br />�r � 1. All calls for in5pection shall rs made 2� hrs. in ndvance - Phone 259-$$10. <br />f1 ?. All work shall he performed in nccordance with Ihis permit anA current City ei Fvrrett Design and Con;t!uCtion <br />S:antlartls and Specification;. <br />3. Call Location Underground Service 4E3 hrs. before you diy. TOLL FREE NUMBER 1-800•424-5555. <br />!e ..�f I.� _ 1 l <br />i <br />� C �� � <br />� �► J <br />APp�oved for Conslruction <br />�..� � �-%--.= <br />8 -7 -8 j <br />W <br />H <br />� <br />I•\ <br />u <br />�' <br />� <br />� <br />a <br />�CKNOWLEDGEME�T OF CONUITIONS <br />The undersi9ned owne�iapphcant hereby a9rees to hotd �nd save harm� <br />less the City of [vercit irom any �nd a0 claims lor dama�es. cosis. <br />expenses. or causes of actien that may arise Uecause nl installa�ion <br />and mainlenanr.e ol the nnpro�•ement or other righl-of-way use here�o <br />applicd br and turthei oqrees to remove same upon noiice from ihe <br />Date CtlY and to repincc puUhc properry dama9ed Ihere6y. <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259��Bt0 <br />Si9n�turc of Apphr.ant Dale <br />WOFK AUTIiORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OP DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED FiY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJ[CT OV[R 90 DAVS DURATION. <br />