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1� <br />Date�� T� pOSTING -1 � <br />Applir,atmn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />n,un. wo... vyyn�y—�� 7����1{����.j��"..q,,/ � <br />rainn o�o� • 5-�--1_�.Oi ✓'��1 � <br />{'�iroirWmbfee " � -- ��. . .. . <br />tmnlPea �--� <br />leff I�ppl in� Pe�tl f -- <br />BA111II�.p Ilu1 f � <br />'77L1-3�� <br />Apphcent Maihng Address Cdy Zip Phone <br />Descnbe Proposed Work �� 1 ) �� �� _— — — —_ <br />Pro1ac1 Addrese (i1 known) �—��� <br />Attach lour (4) copiee ol plena lor p�opoaed work � Drew lo scele entl nole Ilre lollowing as eppliceble; <br />• Prope�ty Lines <br />• Outline end dii.ianvons of �II e�ieUng end <br />proposed aVuclures on tha lol <br />• Exlstmg and proposed uti�i�ies <br />• C�+nterhn.. ul atreat <br />• Indire�e No�th <br />• Show eny propoead qieding cF�n��as <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor Inapecllon shell be mede 24 hra in edvance - phone 289•H810. <br />2. All work shell te FeAormad In accordence wllh ihia permN end current City a1 Everett DealBn end Conslructlon <br />Rtenda�ds end Specl��catlone. <br />3. Call La:atlon Underground Sorvlce 4B hre. before you dip. TOLL FREE NUMBEA 1•800•424-55$8. <br />'�� GL �flnl F%vT r/: STIN� �'�c'; • ctic7z <br />_`>TAND PI � G�F' SCWEZ i N i='/�/ <br />'� )�T�� � G�;� �, rhnF �"�� <br />i j-� ��J � <br />'fC.eac.i�./�/��-e- ��— �� <br />Ap}rov ur Cons!�uc�ion /., � Date <br />. _�— <br />� /�' ' � - <br />,«. <br />, <br />FINAL INS�EC O / � �P <br />Approved es ConsVucled <br />rvPrrtl PUELIC \YURKS DEPARTMENT <br />� 3200 Cader Streel <br />EvernlL WA 98201 <br />Phona 259�BB10 <br />HCKNOWLEDGEMENi OF GONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownei/epPhcnnt hereby egrees �u hold end sn��e herm� <br />less the Gty ot Evaretl Irom eny and all cl„Ims for demeges. cosls. <br />Proense5, or tause6 0l ecUon thBt mey erie9 beceuse of in5tellnlion <br />vnd mnm�enon�? ol the imp�ovemenl o� olhe� nghl-ol�wey usr here�o <br />Ppphed Irn lu�lhe� 0grees lo remove 6B��e upo� notlr,e �rom the <br />Clly and ice puhhc property tlamaged thereby. <br />z(��, �� ,c,L'� .P'� - � <br />S� ure ��//,pPhcant — —� Oa1e <br />WOIIK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br />1B0 DAvS OF DAfE PERMIT IS ISSUED AND THEREAFTER IS �f0 <br />BE L'ILIGENiLV PURSUED TO COMPLE110N. THIS PERMIT MAV RE <br />CANC'ELLED BV THE CIiV UPON ANV STOPPAGE OF WOFK ON THIS <br />PROJFCT OVER 90 DAVS DURATION <br />