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� r <br />�a�e � <br />Applicatlon For <br />PUBLIC WORK� �ERIVIET <br />Prin? �r Type Only <br />C�6AJ1� <br />Mallinp hddress <br />�W�V � <br />Applic-n� Mailinp Addiess Gry Zip <br />Describe Proposed Work �N��� o`o / %f%��i [�DIUCQH7� �.et(�tt�//Fy <br />Pro�er,t Address�il knewnl —�/�� — �'S �� /—L. �/✓ <br />Allech lour (4) copies ol plans for prOposed work - Uiaw to scnle and note the following es applicablrz� <br />• Property Line� <br />� Outline and dimensions ol all existing and <br />proposed struclures on Ihe lut <br />• Eelstinp and propoced utillUes <br />PERMIT CONDITIONS <br />PueOc Worh� Permp • v'�� )� ��� <br />Blaa peD� � — �SL'Y-" •� <br />PuEI¢ Worh� Fae <br />lo��i Poe � <br />Len�pPl fe�PUE S ') <br />B�I�nce D�n i �U� �v <br />• Centerline ol street <br />• Indicale Nonh <br />• Show any proposed yrading chnnges <br />• Show measuremenis <br />%,p336 <br />1. All calls for inspaction shall be made 24 hrs. in advance � pnnne 259•881 5. <br />2. All woik sball be performed in acco�dance wilh ihis pennll and current City ol Everetl Desi�n and Conslruction <br />Stendards end 5pecilicalions. <br />3. Call Location UndergrounA Service 48 hrs. belore you diy TOLL FREE NUMBER 1•800•424•5555. <br />< [� �// <br />/ - <br />_ .C�1fL' (J'?D^.�== //�/ 'j's <br />Approved lor Conslruc�ion � <br />-�. i� �g�,v-� • -1 23 •8� <br />FINAL INSPECTION � Dato <br />Approved es Conslructed <br />rverett FUBUC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone'. 259�E3H15 <br />ALKNnWL[OGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />ThP unAms�yned ow� �r/applicant hereby apiees to hold and seve harm� <br />less the City ol Everelt Imm any antl all claims for damages, costs, <br />expenses. or causes of achon Ihal may arise because ol inslalletion <br />and mainlenance ol the improvemenl or other ugMrof�way use hereto <br />apphetl lor and lurhe agrees to remove same upon nolice from the <br />Crty and to replace p Gc property damoged therqby. <br />; <br />. � ��<�. �-��" <br />Sipnalu�e ol ApP� can Dale <br />WORK AUTh10RIZE �Y THIS PERMIT NUST BE STARTED WITHIN <br />1B0 DAYS OF �ATE P[RAiIT IS ISSUE� AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLEiION THIS PERMIT MAV 8[ <br />CANCELLED �v THE CITY UPON ANV SiUPPAGE OF WOFK ON THIS <br />PROJ[CT OA'EN 90 DAVS DUFATIQN <br />