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Date �' "' � s <br />Appllw�ion For <br />PUBLIC WORKS PERMIT <br />Print or Tyce Only <br />�,�, ,v,..,�.,�„� � 3/L. <br />���v o��� . � �/a �z---- - <br />vubbc Worxf Fea � � � � <br />Tntol fee �— <br />Lren AO01 F�e Pntl f <br />Be'ence �oe S �r� U — <br />��'�' <br />_ l!lyden Rca1_ty inc�• _ 11?3 Dioadway F.v__.�tt 9820� �J� 1:S :---- - <br />--Ovmoi cln��. og Add�ess CitY ZiP ��,n��i. <br />�C'1 <br />_ - :;� <br />Mvlling <br />Clry Zip <br />Desr^ a Pra�06nd Work _ NeH sint.Le f(tm; l_v re_�:LGS: --- <br />Projoc 1 AAdress (II knownl <br />Aflnch lour (4) copies ol plan5 lor propoend WorA ..�aw �o sca�e ond nnte ihe lollnwing es applicable� <br />• Property Lines <br />• Oulllna end dim�nqitns af nll ezlsting end <br />proposed stn�c'ures on Ihe �o•. <br />• Existing end pi000seA utilides <br />• Cenlnrline ol slreel <br />f InAicate North <br />� Show any proposetl greUing chnn��es <br />a Show measur..rnenis <br />sr y <br />PERNiII CC�V�`i1luN i <br />I. All culls ii� insoection siall Ue ma:te 24 hra. �n edvance pnnnn 2$9•88� rJ. <br />?. PII N•ork shell be perlorm?d in .-c :u�Annce with'his permil and a������ City �il Everelt Design imA Consirur,tiun <br />SlnrdarAs nntl SpecdicuGons. <br />7. :?II t ocatlon Underground Srrace 4R hre hc�o�r ycu dii7 TOLL FREE NUMBER i•0�0•424•5$$$. <br />__— _ —_. _—_— __. -f:_ __..�_._._ _ . . <br />—'�� , <br />� <br />� .�,�,� /�-/�'-�j— <br />pproved �or ConstfuClinn Da�e <br />/ �7 <br />� ��ti� . i � ( � <br />FINAL INS� De�e <br />Approved as Constructed ��.�i <br />i�.��mlt PUBLIC WORKS DEPART ENT <br />� 3700 Cedar SVeet <br />Evrre;�, WA 98201 <br />Phare .^5'�-F3B1$ <br />:,CKN�_�1V1 f ���GCt!('+1 Of CON�I��ONS <br />W <br />� <br />� <br />N <br />i i��� unArr,ig��ed owncr, aP�6canl hdnaby agrees to holA end save harm� <br />i�•;s �he Gity ol Everett Irom any and all cleims lor damayes, costs. <br />.r.penses, or Cnases ot aclinn ihet mBy erise because ol in5telletion <br />and maintenence u� t:ie Improvement or olher ripht�obway use herelo <br />appl�ed tor o�tl Wriher ag�aes to reraove seme upon notice Irom Ihe <br />City ond to renlace Puhlic property dimagad thrreby. <br />i <br />.. ' C' i � i� .' �.� J ,li <br />�-" \ .c. ... � .� __ `� _ <br />yigna�ure ol Applican� ��« <br />WORK AUTHOR12ED BV THIS PERMIT MU51 BE STA9TED WITHIN <br />180 DAVS OF DATE PERNIT IS ISSUED AND THEFEA�TER IS TU <br />BE DILIGENTLV PIiRSUCf1 70 GOMf'I f1iON THIS PFF7MIT tSAv �E <br />GANCELLED BV : ��� � , w •.� • . , `..'r�r^;,r,f U( VJ[�Rr. � ��J 1�n5 <br />PRO1F�.lfri��f1'�� f�:.�..���.i.;;.��.`.. <br />