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L�l �i � <br />m�x <br />ay� <br />H'A3�. <br />yzH <br />� H� <br />� H'�J <br />fn H <br />H <br />xx <br />m H t7 <br />OH[y <br />N CiJ O <br />4] � C] <br />9H� <br />Y <br />t f-+ H <br />� <br />H <br />f] (7 CA <br />C�1 � Cs1 <br />Z H b1 <br />H O Cn <br />C� <br />� � <br />_� <br />I �j <br />�r <br />�� <br />! �- <br />, <br />Y � <br />Date 7�� <br />� <br />Applicalion For <br />PUBLIC W7RKS PERMI� <br />Print or Type Only <br />Address <br />Descrihe Proposetl Work <br />City <br />City <br />�� a��o���wo�nsrmm��i. — <br />eioe oca�.• ��� - <br />�7 <br />Pubhc Ylotks Fee S <br />iotal Foe <br />tees Aop� Fec Pa�O S <br />a,�,���o�,� s <br />-vf ,353-7G�13 <br />Zip Phonc <br />-��t�n 9817n .3.3��-o97y � <br />Zip Phone <br />,. _ � ,�., � �, _ ; ,= U <br />Proi"-ct Address (il knownl - �' <br />A�tach four (4) copies ol plans lor proposed wo�k � Draw to scalr and note the fo!lowmg as applicable: <br />• Prope��y Lines o Cenierline ol siree� <br />O Outlint and dimensions o� all e+�shng nnd • InUicate Norih <br />proposed structures on Ihe bt • Show any proposetl gradin9 channe; <br />O Exis�ing antl proposed u�ilitics • Show measurements <br />INE <br />PERMIT CONDITIONS <br />t. AII calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2 All work shall be pedo�med m accordance with this permit anA curreN City ol Everett Dr.si9n and Consiruction <br />Standards antl SUecilicalions. <br />3. Call Locaticn Under9r�und Service 4D hrs. beloro you tlig. TOLL FREE NUMBER 1•$00•424•5555. <br />.j <br />/, t �.i )„�,j �� . ;c�.� ��l <br />.� . ����`�'�°��"� •/��«<<<<..<; �:�. . -� <br />_�/ /� �'n %�-�LC�-l_ce /G'�'z!=',�j� �» r;c<:�(('Lc <br />i, � � , �. <br />' ,,, ,«/' <br />,�, .� � <br />� <br />, �� ;. . <br />Approved lor Conslruc�ion Dalc <br />FINAL INSPECTION Date / <br />,qpproved as ConsVucted � <br />/ PUBUC WORKS DePARTMENT '-� <br />320C Cadar Sireet <br />Evcrott, WA96�01 <br />Phone 259�6D10 <br />� ! <br />W <br />� <br />�w <br />�! <br />W ' <br />O ' <br />♦ i <br />i� <br />O <br />�CKNOWLEDG[F.1flNT OF CONDITIONS <br />lhe undmsi9ned owneVapplir.ant heieby a9rcos to hold and save harnr <br />Ir�::�. ihe Cily of Everelt irom any nnd all claims lor Aomages, cosis. <br />nnpenses, or causes ol action that may arise because of installalion <br />,ind maintenance ol ihe improvemen� or other rigM�o��way use hereio <br />anPlied for and lurther a9mes to remove same upon no�ice Irom the <br />Gty and to rj�� lace publir, property dama9ed Ihereby. <br />� %/ � � i r%�%/ <br />lSi( c'S1 Applirant 1°'�; <br />ORK AUTHOAIZED BY THIS PERMIT MUST B'c STARTED WITHIN <br />1d0 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSUED 10 COMPL[TION. THIS PERMIT h1AY BE <br />CANCELLflD BY THE CITY UPON ANY STOPPAGE OF WORK ON �HIS <br />PROJECT OVER �JO DAYS DURATION. <br />