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oe►�s���� <br />Appllcetlon For <br />PUBL�C WORKS PERMIT <br />Print or Type Only <br />CC:�P'� t 1t L A►.� � <br />�� <br />� SA � e <br />Applicent Meiling qddrese <br />Deacribe Propoautl Wo�k — ���� <br />� <br />� <br />v„euc Wor�a c n• O�-3�+ <br />BiJp DeO� • i5 <br />Puel�c Wor�� Fea <br />Tolei Faa f <br />�P�fi �no� �ae PuU i <br />Ba��nre Due � ��"� <br />Projact Addreas pl known) 3ia - i���sr_ _sF ��, <br />� -,—� <br />Attech lour (4) coplae ol plane lOr proposed worh � Draw to scele end note Ihe lollowmg qs epnhcnble <br />• Proparty Linee <br />• Outline and dimen�ions ol ell erleting end <br />p�oPoeed afructures on Ihe bt <br />• E�ieling and proposed ulilif�es <br />�,s <br />c� :�Ar � f,. <br />• Centedina ol slrept <br />• InAicate North <br />• Show eny proposed qradinr� changes <br />� Show measuremenls <br />Pi�RMIT CON�ITIONS <br />1. All cells lo� inepection shel, be meda 24 h�s. In advence � phone ZS9•BB� B. <br />2. All work shell be perfo�meo w accordence wil� thls permit nnd cunent Ciry ol Everett Design enA Conslruclior. <br />Stendards entl SpeUlicetlona. <br />3. Cell Locetlon Undarg�ound Sanice 4B hre belora you diB� TOLL FREE NUMOER 1•800•424•5555. <br />� �j ���� ._!F;.�,, _�' i('.- �'s�o.J d" Li 4',7'.C:.�.(L�..✓, f%.!.S/ !)Nia��,-l•E,J <br />SiOEu�Ac..t S/Y9cL .9F �Fi�C�CFL� ��. <br />S /iNj� L+.C/�l�i.t/[�/ /_�f� TNF LUT i.t'4.:L /.'� � 7l.t��E •�r'� <br />9� ,UDT 7<? <br />5 Ii�l�I.�CT %/G- .Sc'.,. �'N2 �i,n_. /�����i',i•/. FS <br />s..�ir/� .("if..va�.r�Tls' �Li✓� C'f%- <br />9 �./�-�i �//�G <br />Approved lor Conetructian Deta <br />�/ ' ���t <br />FINAL INSPECTtON Dele <br />Approved ea Conalructed <br />eoerelt PUBUC WORKS DEPARTMENT <br />� 3200 Cetler Slreet <br />Everell, WA 98201 <br />Phone 259-8915 <br />ACKNOWLEDGEMENT OF CUt1DITIONS <br />-a3i <br />� <br />O <br />The undersigned owner/epplir,ant herehy agrxe£ to holtl and enve harm� <br />less Ihe Ci1y ol Everett Irom eny and ell olalms lor demeges, cosis. <br />e•penses, o� cBu9es of ecti0n Ihet mny B�ise betnuse cl installahon <br />anA maintenence o� the improvement or other nghl�ol-wny use Y�velo <br />eppGed br nnd Iwther agrees tu remove seme upon nolirn hom ihr <br />Ciry nnd to raplace public propaity •.vme7ad Piereby <br />Signa ure N AppLr,ant --J�%���� —.— <br />[Ja1e <br />WOFK AUTHORIZED B� iHIS PERMIT MUSi BE STARTED WITHIN <br />�80 DAVS OF UATE PFFMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCEI LE� BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION <br />