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1 <br /> . 1 <br /> ' � I � ' p � 4a��l���C 1Vnr�tV.yl �I'r� <br /> �,l l l' _ _ . �y � )�j <br /> p.inn oeo� . —,,,,_' . .1_ ,tl?�"fiilo—. <br /> Anplic:,ticn for �-- '-- <br /> PUBLIC WORKS PERMIT "��°°°"'°„°`�P -- - <br /> ,��.�F�� s_ <br /> wrH <br /> � ,,,A��� ����•:,� s — <br /> t�7 m e,;.,��:�o�„ s _ <br /> p�x Print or Type Only <br /> Q f+ <br /> 9HV� <br /> y �� f -('; - ���: l� <., 1`7'�'�'�'J'� �=�1 }f?"�� �k,�C?I _ <br /> � y� �Ownei �Ma�mp AtlOress � C�ty � Lp P�one <br /> '� �� ���/�-� � <br /> x, Z� ApplicaN hladinqAddress Cily Zip Phonc ' <br /> lT1 O � <br /> HC -�/ --T--��n'' � <br /> :V �C7 DrSCribc Prpposed lVOrh �� v �I� ' `!� ,l�� �. <br /> O <br /> G]� O❑ i j <br /> x H tn <br /> � Hy W <br /> v, � r ] � � <br /> M <br /> p ty(p ProjeCt Addre55 U�knownl � � <br /> � �� Altach fow lal copies ol plans lor proposetl wo�h� Draw lo scale anA nole ihe lollowm9 as apPlicable-. � � <br /> x y y � Property Lines • Cenlerline ol street � /^ I� <br /> H O t/� • Outline and d��mensions of ali e*�shng ana • Indicate Norih V� � � <br /> proposetl slructures on'he lol • Show any PrupoSed 9ratling changes ' I <br /> • E.isting and proposed uu6Les • Show measuremenis /� 'i � <br /> DO NOT INPITE BELOIN 1HI5 LW[ O I � <br /> � PERMIT CONDITIONS <br /> 1.All Calls loi inspection shall be made 2d hrs.in advance�phone 2$9•881�. � � <br /> 2.All work shall 6e pertormed in accordance with Ihis permit and curtent Ciry of Everelt Design and Conslruttion � <br /> �„� Standards and Specilications. <br /> � � 3.Call Localion Undergrountl Service d8 hrs.helore you dig.TOLL FREE NUMBER�•800•424•5555. � <br /> � 1 C � � �''�l�(�-.� ��� � (�� <br /> �`' ' i O <br /> �� � <br /> �� �� � <br /> � � � � <br /> � � ��C��� �� l� �� ��`` <br /> __ � O <br /> a <br /> � ACKNO\b'L[DG@MENT OF CON�ITIONS ' <br /> ' � The undersi9netl owner/applicant hmeby agrees to hold and save harm� �� <br /> � less Ihe Gty ol Everelt 4om any and all claims lor damages, costs, �i <br /> �"`'+! e.pr.nses, or causes ol action ihat may anse because of installahon <br /> and maintenance of Ihe improvement or othe� righl-oFway use hereto ', <br /> applwd lor anA luriher a9rees to remove same upon notice Irom Ihe i <br /> Approved for Conslruttion ���� Gly an�10�ep��ce public pmpeity dama9ed ihereUy. ', <br /> I <br /> I <br /> FINAL INSFECTION ���� I <br /> Approvetl as Gonsuucled Siynalwe ot ApP�icant �ale <br /> WORK 11UTHORIZED BY T4i15 P[f7M1T MUST BE STl1RTED WITIiIN <br /> racrt�ll PUeLICWORKSDEPARiMENT 180 DAYS Of DAT[ PERM1IIT IS ISSUED AND THEREAFIER IS TO <br /> � 3200Cedar5tmel BE DILIGENTLY PUFSU[010 COMPLETION. iH15 P[RMIT M11AY BE <br /> Everett,WA 98201 CANC[LLED BY THE CIiV UPON ANY STOPPAGG OF WORK ON THIS <br /> Pnone:259�BB10 PROJECT OVER 90 DAYS DURATION. I <br />