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. i: <br />Applic�tlon Fo� <br />PUBLIC WORKS PERMIT <br />Pr�ni ei Type Only <br />DneND� Propo�ad Werk <br />PrW�cl Addren pl known) <br />� <br />.��,. .. <br />.� o.� . i <br />PuOMe WOM� FM <br />TM4fw / <br />lN� 11pp1 Fw Mq / <br />au�a ow <br />' �i3 J � <br />..I <br />[�p <br />p <br />��3 -�63� <br />'J�� - GG/„� <br />Afl�ch fow (�) coDb� ol plm� for propoeed work - Drew lo ecele end note Iho tollowinp ee applirebta: <br />• Prop�rty Line� • Cen�erllne o! utreel <br />� Outlins �nd dlmenUon� ol dl ealslinp and • Indicet, North <br />propo�sd �truclure� on Ihe lol • Show ony proposed pradinp chanpee <br />• Ezltllnp �nd propo�sd utltltlee • 3how meaeu�emente <br />PEfiMIT CONDITIONS <br />t. All cNl� lor In�psctlon sh�ll he mede 24 hrs in advence • phone 269•8816. <br />2. All work eh�ll ba parlormed In eccordence wlth Ihle permll an0 current City of Everett Desipn end Conalruction <br />Standud� �nd Spaciflc�llona <br />3. C�II LocUlon Underpround Servica 4B hre. betore you dig. TOLL FIIEE NUMSEII 1•800�4Z�•666b. <br />App�owE for Conatructlon Date <br />FINAL INBPECTION Dale <br />Approwd u Conatructed <br />everett PUBLIC WOF� S DEPARTMENT <br />� 3200 Csdu Stroet <br />Everett, WA BB201 <br />Phone: 269•8816 <br />�,e, ,�,-� <br />iP5 <br />u � �. .� �V <br />� - 9 -� ,�Ge�•�--- <br />ACKNOWLED(3EMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undereipned ownedepplicanl he�eby apreae lo hold and eave harm• <br />leae the Clly ol Eve�elt Irom eny end all clalme for damapea coel4 <br />expeneee, or caueee ol ectlon thal may arlse becsuee ol Inelelletion <br />end rrelntenance of the fmprovament or other ripht•ol�way use hereto <br />epplied lor and lurther apreea to remove eame upon nolica Irom Ihe <br />City and lo replace pubNc property damapaE theraby. <br />Slgne W re ol Applicent Date <br />WORK AUTHORiZED BY THIS PERMIT MUST BE STAiiTED WITNIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIOENTLY PUFSUED TO COMPLETION. ihIIS PERMIT MAV BE <br />CANCEILED BY THE CITV UPON ANV STOPPAOE OF WORK ON THIS <br />PRO.IECTOVEH BO DAVS DURATION. <br />