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l <br />Oate��L1'��� <br />Applir,�tlon For <br />RIJDLIC WORKS PERMiT <br />F'rint or Type Only <br />P�dtlm Wm4e Paimi _! /7� . <br />Fli�O Depl • � �I 7 � � <br />�—l�� l <br />Puttl¢ WorF�fee s --_—'_ __ _ _ _ <br />touirru <br />leaa Appl Iee Paia S <br />20 �_-- <br />Oalnnce �ur S -- <br />:�C�t.(Y?C' — <br />Applicanl Mnihng Addross Gty <br />Uescribe P�opo<ed \Nork `11J—` �- <br />Z,n <br />Pwlai AdAress Ut knownl �`—t,-- �J� � `"�• JE _ _ _— <br />qlVir.6 Iow Idl copies ol plans Im ��ronosed work � Draw Io scaie and note the followm� as applicabie <br />• Property l ines • Cenlerhne nl sireet <br />• Oulline and dimensions ol all e.islin9 and • Ind�cate North <br />proposed struCWreS on Ih� lot • Show any p�oposed yradin9 ch�nyrs <br />• Existing nnd proposed utihtics • Shuw mcasuremrnls <br />LIN <br />PERMIT CONDITIONS <br />1. All calls for inspect���n Shall he made 24 hrs. m. dvance - phone 259 B8i O. <br />2. All work shall be peiioimed m accordance will� this permi� and r,urrenl Gi:y of Evmeit Desi9n and ConsL•uclion <br />Standards anA Specilications. <br />J. Call Localion Underyrountl Servico AEi hrs tie�oie you di9 TOLL FREE NUMBER 1•800•424�-5555. <br />—�� ------ --------- <br />�.��ar' .> > / �5� ,5'ti <br />�G� �a�-f�— 5 <br />Approve r Consirucli ��� <br />i � <br />i �,� /G� �/% �k � <br />FI AL I � ON � Da� <br />Appr000A as ConSirucleA <br />�y��.��.�� PU�LIC WORKS DEPARTME' - <br />� 320G Cednr Slreet <br />Everett, WA 99201 <br />Phone 269.NntD <br />ne <br />AGNW065'LI_DGCIdLIrTUI Ci>IJDI71bNti <br />W <br />� <br />! <br />N <br />� <br />O <br />�w <br />� / <br />� <br />a <br />7 h�, undai5y�ooA ownovnPPLcani hmebY ay�e�s to holtl and save harm� '. <br />i�•��,�, Iho Cdy nl [verett Irom any and all ciaims lor tlama9es, costs. <br />expenses. ar causes ot �chnn ihat may anse because ol Inslallatlon I <br />and mamlenanCe ol the imp�m�emen� or othe� nghbol�way use herelo � <br />apphcA lor and lurthcr �yree, to remove same up�+n noticn Irom ihe ' <br />C�t�� and to replar.e Puli�i� P�oprrty damageA Iherel y. <br />��ll. �� �_-� t z - -- �/- `>' ��% <br />Siynalure ol ApPGcTnt ��I�� <br />WORK AUTHORIZED Y THIS f ERMIT MUST B[ SIARTED WItI�11N <br />180 D�YS OF DATf PERMIT IS ISSUEJ AND 1HERE��TEf� IS TO <br />BE DILIG[NiLV PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br />CAKCELLCD BV THE CITY UPON ANV S10PPAGE OF WORK ON T1115 <br />PROJC CT UVER 90 DAYS DURATION <br />