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D�.te��-��' <br />Apnlication Por <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />/ <br />r��nec Worke Pe�md • / � /'S/ — / <br />Nntp Orn� • -- <br />f'un��c wods fec s <br />.o,.� ��. --- <br />i�e.�on� v�rre,a S !, -- <br />Ne�nnre Dun s c� C� !— —_ <br />�Y. ,.�y.-i , i <br />��n nn.�. <br />VWliv-i <br />�� �S <br />P.pplic �nI <br />D��scnoo PruPnsed V.'ork <br />� {�u�u/c. � <br />� ✓rdu.�c� � <br />Prolecl Address UI k�iownl /7/d � <br />I.ng Atldres5 <br />r� <br />Zi� Phone <br />q��, rh lour 141 copies ol plans lor proposed work - Draw to sr.Ne and nole.�Cl�ol'owlne ol sbe'e� �"I`' <br />y properly lines � Ind¢ate North <br />• Outhne :�nd dimensions ol all e*ishng anA � S��oN, Tny pwposed y�ad�ng r.hanyes <br />proposed sl�uctures on Ihe lo� � Show me2surements <br />• E.islin9 and p�oposed Wililips <br />PERMIT CONDITIONS <br />1. All calls lor inspection shell tre mede 24 hrs. in advance � phone 259•SBi 0. <br />2 All woik shall be performed in eccordanCe with lhis pennit and currenl City oi Everett �esign and Construchon <br />S�andards and SpeCi�ications. <br />3. Call Location Underground Sernce 48 hre. betore you dig. TOLL FREE NUMBER 1•800'424•55 • <br />� . J,..,t� r•c.n� f,i 4� /J... ��,� :>� l� r.�. �/ <br />%J �'.� . ,-r /• • � �� U <br />t �,�:L/,'a: � /. G. <br />�. 7nk..,.fcJ.•� ti .,:�.i, h�...... �/ / �, ' .- <br />�,•.�'/.e�( � /• �i l,i� I/ <br />� . �C Ii .7 i � <br />l . �� � / � / i r� i � �,E. �� <br />lJ�: ktr..�. .., t� �� <br />f � 'i,. _L1nt � Y �lPc,�f �'/ h��"S' � �� /,�.. . �/ <br />i kr,lJl. �/'!t� v! ,�� . . <br />�. <br />tr f�: Cl»u.�L �i./�� � � �'i I <br />i�'rC� � � � . <br />� � - ,r :�ri �� <br />��� �'t � '-_ ' � ` . <br />l� _ <br />Approved <br />FINAL INSPEGIIVrv ` / <br />Approvetl as Constructed <br />� � PUBUC WORKS DEPAATMENT <br />/ � - 3200 CeAar Street <br />� Evmell. WA 99201 <br />� ruo�e zse ania <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />�CKIJGIVLEDi�GMf_NT OF CONDITIONS <br />�1,�• undrr�iyned owneCnpPli�:���� hciebV a9rces to hald anJ save haim� <br />b•ss il*.n C�ly o� Everetl fiom any and all clairns lor damages, r.osts. <br />raper.ses o� causes ol action that may arise br.cause ol inSlalla�ion <br />and mainlenance of the improvement or other nghhol�way use herelo <br />anphed lor and lurther agrees to remove s�me �pon notice Irom the <br />Cdy nnd lo ienlace public propeily damaged U�ereby. <br />f��o .�� <br />UJ�i <br />Si9n e ol ApPhcaM <br />1�OjDAYSjOFORDATCD- PERMTS SESSUED ANU THEREAFT�ER ISHTO <br />BE DILIGENTLY PURSUED TO COM1IPL.[TION. TNIS PERMIT MAV BE <br />GANCFLLEU OV THF CIiV UPON ANV STOPPAGf OF WORK tlN THIS <br />r�Ao�ect ovt_�a en nn�'s our�nrioN <br />