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�,; <br />;;r. <br />,-. <br />� <br />� <br />��� <br />9H <br />� � H <br />ayxv� <br />H 93 <br />y zH <br />� H� <br />'�s� H'=7 <br />NH <br />y zr <br />� H �G <br />H L�T7 O <br />G] � C� <br />z? H� <br />r t-� H <br />g`� <br />H <br />nC�d� <br />[sJ � L�f <br />y O cyi� <br />!�"� _._,T��_ <br />___---.. . <br />„ . . r ; ` ,. .., _- <br />� Date ` ` !r/G � <br />� <br />qpplication For <br />pUBLEC WORKS PERMlT <br />Prini or Type Only <br />� � ���,�,�:•,�,.,>��„�.,, _ -,-- <br />t � <br />[iio � o�,n� • _._'rts-.'v:-�-%—t--. _ <br />PubliclVO'kSFCC 5 <br />TolaiFce <br />inss/.00� FacPa�a 5 <br />Baia�ce �ue S <br />'. ., <br />1 L , - -� ' 'ii %-.�,:�:1 � <br />�\ I1�/' ( �� / (i /. !_� J.,�l �l' �ii� � ^ 'Ci�Y LU Phon� <br />Owner Mailing AAdress <br />'i'%r; lA ✓C� <br />App�icant <br />Describe Proposed SNork <br />�� Y 1, <br />Ma�ling <br />;L <br />' ' � r. . /r <br />prolP��Atld�essUfknown� �'�!1='1_ ��-�--r;.-� - <br />qtlach lour In� copies o� p�ans for pronosed work - D�:��: !�� ��-�,i^ ��"�� nob, U�e foliow�n9 as applicabie. <br />• Properly Lines • C�enterline of Slreei <br />• OUlhne and dimensions ol nll c+islinq ;ind <br />• Intlu�alc NOrth <br />prOPosetl SIruCWres on Ihc I�A • Shoc: [�ny proposed ql�ldm{I chnnqes <br />• Exisiin9 and ProPo�etl uldiiics <br />• Sho•n med5urqmeni5 <br />rr� <br />PERPAIT CONDITIONS <br />7. All ealls (or inspec�ron shall be made 2C hrs �:i advance � Phone 259•881 G. <br />2. All v:ork shall Le peitormed in acm�d�nce w'dh this pe�mi� and curtenl Ciry o� Evr.re�t Desl9n and Gonstruchon <br />Standards and Spetilir.alions. <br />3. Catl LoCation Under9wund Serv�ce aa nw. U�:low you Cig TOLL FREE NUMBER 1•800•424•55.ri5. <br />�!-�������% <br />Approved �or Consiruchon <br />� <br />/;' <br />r. <br />f� <br />� <br />�w <br />�� \/ ij <br />�✓ i. <br />_,- . , . ,.. . i <br />�� /� . .' _. .. ...-. �� - . . <br />� ,,; ,�:. ��r � , � a �� <br />'� ,, ` -, ��.� <�._ �-� � <br />;� �, . � , <br />�, , , f " �� � , i. <br />:��/<1,�.��,, . -/ 4 <br />. y�����'��/ �•- " ACKNOWLEDGfM1tENTOFCONDITIONS 1 <br />� /' . <br />n � 'J�ff��:'G� lheunder;i9n�dov+nrr/apPhr.an�herehYa9reesloholuandsa�ehann� <br />� r� " R / <br />l less ihe City ol Evaelt Uom any and a�il r.laims for dnma9es. r.osts. <br />-- I expenses, or cnuses of �ction �ha� inry arise hecause of installation , <br />I:�nd maintenance of ihe miprovemenl or o�hcr uqh4ot-way use t�erelo <br />;�pphed foi and ��������'� �9rees to remove samc upon notice irom �he <br />Da�e Ciry mid Io ieplace Pu61�c propr.rly d�mn9ed �hereby. <br />. FWAL INSPEi,TION <br />I App�oved as COnstruc�ed <br />. i,�„���� pUEUCWCRKSDEPART!dENT <br />� 3200 Gedar Siree� <br />Everett, WA 98201 <br />Phonc 259�8810 <br />Dalc <br />Signaturc ol App���an1 ���` <br />WORK AUTViORIZE� BY THIS PERMIT MUST BE STARTED WITF!IN <br />130 DAYS OF DP.'.0 PGRMIT IS ISSUED AND THEFEArT[R IS TO <br />BE DIUGf_NTLY' PURSUGD TO COMPIETION. THIS PERMIT MAY BE - <br />CAhlCFLLED BY TH[ CITY UPON ANY STOPPAGE OF VJORK ON TNI�'• <br />PROJ[GT OVER 90 DAYS DURATION. 'i <br />