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Datel�'y�S <br />App'-etion For <br />PU�LIG WORKS PERMIT <br />PriM or TyFe Only <br />'C" Sr <br />Zlp <br />oum•c wr� rmpm��t —• ��S--/ �J� <br />Niao Deo� � y_��zJL�� <br />Pubpc WOK� (N <br />TolelFse = _ <br />Lese �p0� �ae PUU Q <br />B�bnce �oe i Z� � <br />8ati7s <br />� /N � <br />Applitant Malling qdtlress Ci�y Zip Ph�ne <br />Descrl�e f'roposecl WqrF <br />� <br />Projed Addresa �il known) .��� �G7h� ��L <br />Attach lour 141 copiea ol plans lor proposed work - Oraw lo scale and note the lollowin� �s nnplir.aUle�. <br />• Property Lines <br />• Outline end iimenelons ol all existir- nnd <br />proposed St�uCtures on ihe lot <br />• Exiefing end proposed ulllities <br />• Canlerlir�e oi sl�oet <br />• Indicete North <br />• Sh.ow eny propu��° : 9rndinq chanqes <br />• Show meosn�em�� , <br />Pf_RMIT CONDITIONS <br />1. All cells for inspeclion shnll be made 24 hrs in advance � phone 259•8815. <br />2. All work shall he perfo�med in accordence with this permil and current G!y ol Everett Devgn and Cunstrucllon <br />Standards ena Opecllicetions. <br />3. Call Location Underground Service 48 hrs. tr+�ore you dig. TOLL FREE NUMOER 1�B00•424•5555. <br />T c�Xisr�.vG S�l�f'u/acXS f1.eE .tiw/B.Q'c�.cE�tJ .4,vU i.�/ Rlf-sJ <br />�tw��. liO.t � Ti/E •d/'/'iicaNT is .('Eqt.v.�Eo %7l .PEP.�4CE <br />stvf/ _fiaF�.cacX Ii4m�IsEO UG.P..« (�cwS�UtTip,�/- <br />� iC'oof c�0[s� Sii�UTS A�PE To BE T6.�Y�_ Li,v<<p <br />/O EX �STiN�j C� ��� (�,ed iN1, <br />�. A,v/� G,eeo..r.�� o� 7yE� [ar /s �o aE �o.vE <br />St� As A/c�T Tv I�i'vcT TJ� Su.e,Poy,v�.itJG <br />L'�+ � /tiiT.s' .Pd�.r/— /defE'.e .Pi-�*/ Uf%!� <br />`71�L l�iv,.�� /D-af�gs <br />Approved �or onstruction Date <br />L T <br />FINAL INSPECTION Date <br />APprovad es Conslructed <br />rv�retl PUBUC WqRKS DEPARTMENT <br />� 3200 Cetlar S�reet <br />EverplL WA 9A701 <br />Phone'. 259-9E115 <br />_�� <br />ACICNOWLEDGEMENT UF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undnrsiyned owner/app!icant herebp agree5 lo hold and save harm� <br />lese me Ctly ol Eve�ett irom e�y and jll cleims lor demages. costs. <br />ezponses, or causes ol [,cliun Ihal mey erise beceuse of installation <br />end mamlenance a�lhe improvemen� orolherrighbobw0yusrt hereto <br />nppheA lor and lunher agrees to remove sama upon nolice from Ihe <br />Clty and to replace public propnrty a::maynd ihr.reby. <br />�7�.(.�1��n�C..C_�2.h.C..'�_ � V -�L�' � 7 <br />Si9n:ilure o� APP6can1 Da�e <br />WORN �LIiHO�11ZED BY THIS PERMIT MUET :E STARTED WITHIN <br />Itl0 DAIS ��F DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />9E DILIGENTL V PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br />CANCELL ED BV THE CITV UPON ANV STOPPAGE OF WORK ON THB <br />PROJECT OVER 90 D�YS DURATION <br />