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Date��� <br />qpplicatinn For <br />PUBLIC V1iORKS PERMIT <br />Prinl or Type Only <br />P�d�.�,rNnneh.rmi�• — <br />C'l�% I '�> >-�'— <br />Oiao Itrni � —_._S.-1. — <br />PulU�c N'o�h� 1 •e <br />Tob� Fae Q — <br />Leu �ooi. iaa vua 6— <br />e����ce �re S — <br />Apphcent <br />Addross <br />Zi� Phone <br />Describe Propoaed Work <br />-�4`��F--il�'i�if�l��.kr- _- -_ <br />Project Addrese (if known) — - �- ' <br />Attach lour 141 copies cl plens lor propos�d wnrk � Draw to scale end nole the lollowing as appl�cal�tr' <br />• property Lmes • Centerline ol sVeet <br />• Outline end dimenslons ol ell eeisting nnd • Indir.nte North <br />propased 5trucP.res on !ha lol • Show an� propo9ed U��dincl chan9e % <br />• Existing end proposed utilities • Show measurements <br />P[RMIT CONDITIONS <br />I All calls lor inspectron shnll be made 'Ld hrs in advance � phorro 259•BB15. <br />:. A'. work ahall be perlormed in accordance with Ihis permi� and wrrent Cily ol Everett Desi9n ar.d Consliur.l�on <br />� •anderds end Specilications. <br />3 C��I , ocalion Underc�roun�l Servi�e 48 nrs. before you di9. TOLL FREE NUMBER 1•800•42�•5555. <br />ApprUvcd lo� Conshuciiu�, <br />^ b��c <br />�l `° <br />NU <br />� <br />v <br />(( 5,� ��� <br />Cf �' ' J / l <br />� " <br />l� C�`�`/� <br />, -�� �.y.fr <br />fl:ao <br />FINAL INSPECTION Dele <br />f pproved e : Conalructed <br />e�vrrru PUBLIC WORKS L .PARTMENT <br />� :1200 Ceder Slreet <br />f�_v�rell. WA dR201 <br />i�i,�,�,�, ;;��ru���, <br />� <br />� <br />r <br />N <br />O <br />a <br />ACNNOWL[UG[MENT OF CONDITIONS <br />1 hr u�,d��rs�q���d r�� ner/applica�l hereby agrees to hold nntl save harm� <br />�os; Ihe Cdy ol Lacretl Irom any and ell cleims lor demeges. co�ls. <br />��apenses. o� causes o� eclion thal may arise because o� inslal�ation <br />and mainlenance ol Ihe improvement or olher righPobway use herelo <br />appred lor and Wrih�r egrees to rnmove same upon nolice 6om Ihe <br />G�ty end to replace Pubhc pwperty damaged Ihe�e6y. <br />Signaturp ol Applican� Dete <br />WORK AUTNORIZED BV THIS PERMIT MUST BE S1.�RTED WITIiIN <br />1B0 DAVS OF DATE PERMIT IS ISSU[D AND THERE4FTER IS Tn <br />8[ OILIGENTL� PURSUE[� TO C(�����'l!:TiOM THIS P[R(�Il 4�AV PE <br />CANC.ELI ED FiV THE C.TV UPON nFl� `.'nl'I'nGL r�! 1;l-if7r O�J t111P. <br />rr�nii � � ���,:i��+��n nn���; nunntnv, <br />