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Date `3 S� �(_ <br />Application Foi <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Irm�i�c wo,�� rw�mn . _ <br />Bmv �nni • __ <br />PuM,cV;arh�iee s <br />io1M fee <br />Leen �00� iee Pu0 S <br />Bni�nce0m S_ <br />� . _. <br />c_n.cil is yo rv.,�< <br />�Oh �_ �p r r � S <br />Owner MeilingAddiess Ciry Zip Phone <br />�'- �'I , S� 9,��3 o y <br />Cily Zip <br />Describe Pwposed Work <br />Prolec� Address (il known) 7� Z � ( Z ��' <br />A�tach Iour (4) copies of plans tor nroposed work � Draw to scale and note Ihe lolloHing as apPlicible. <br />• Prope�ty Lines • Ceninrline ol street <br />• Oulline and dimensions o� all ezlstmg and • Indicate Norih <br />p�oposed Struc�wes on Ihe lal • Show any proposed g�a9ing chan�es <br />• F�isting and proposed uhhhes • Snow mrasuroments <br />VNL <br />PERMIT CONDITIONS <br />Phone <br />t. All calls lo� ins��ection snall be made 24 hrs. in advance � phone 259•8815. <br />2 All work shall b? perlormed in acwrtlance with IMs pe�mit and current City ol Evr.rett Design and Construcfion <br />Standards and Specilications. <br />3. Call Location UndergrounA Servicc 48 his belore ;ou dig. TOLL FREE NUMBEA 1•BOO•424•SrJ55. <br />// �! ? <br />._Y•f—�'j�i_ <br />/�/��/CdN% /i/dS /,t/fT.E'�'� 7E.l� ; ��� IY�c'✓E <br />/n'E �6.�/LE' !�'.�1�.0 %c� T.✓Eif' /�,�'��%'�'.�'7j/ L�n.'E� <br />l ,� � <br />b:dGC �i�Cm i!/iYE.Cf' i���S>J �1<"E' NUtJ>. <br />��i�i�Cildit/� /L�.OS' ALSL� %L'.!LI Tf//�T A /�v�iLiG <br />,�. <br />�`.'��';�!'GS "�. �'Y/.. n �;. .:,�� if,.c_`�-��� c'(/. ^ . <br />. .%v��' !L �- / ('�/ 7 <br />,�����lr>r/11- <br />ACKNOWLEDGEMENT OF CONDITIONS <br />3 <br />W <br />� <br />N <br />� <br />� <br />The ucAeis�9netl own0r/appliCm�I hefeby agrreeSlO hol� enU Sace hann- <br />--- I�ss Ihc Ci;y ol Everetl irom any antl al� cla�ms lor damages. costs. <br />expenses. or causes oi action ihat may arise 6ecnuse ol inslallation <br />nnA mmnle�ance ol Ihe improveinenl or olher ric�hl�ol�way use he�eto <br />nppiicd lor nnd Iurlher ;iqrer,s to removo samc upon nolice fiom Iho <br />ApProved lor Cons��uclion ��t� CdV .���d lo •enli,.�` pubhc Pr�Perty damn9mf there6y <br />FINAL INSPECTION �ale <br />Approved oe Conslructed S�nn;�I�ue ol nppl�cant Datc <br />ev�rett PUBLIC WOFKS DEPARTMENT V✓OHK AU7HOWZ[U OV iH15 P[I7M1T MUST 8E STARTED INITHIIJ <br />� 3200CedarSUeot i80 I�AVS OF DATE PfFMi? IS ISSUED AND THERl:AFTER IS TO <br />Evcietl. 1NA P8201 BE DIIIGENTLV PURSUED TO COMPLETION THIS PFRId1T MAV B[ <br />Phone 259-6Fi15 CANCFLLED �V TH[ CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PROJ[CT OVGR 90 DAYS OURATION <br />