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Date�r�GL'D � <br />nvotica�icn ror <br />PUBLIC WORKS P'�R�VIIT <br />Print or Type On�y <br />Mai <br />u �, <br />Applicant Madmq Atldre;s � <br />Devcnbe Proposrd Vlmk _ _�J�,_,� _ _ <br />Prolect ACdress U� knownl <br />�, � ��, , .. �,,.,r„� <br />,,,,,,, o.,,, . ,� �l Dl� <br />P��ti6r Non� iee <br />I4�qI�PP `t � _ <br />LeasAnO� ferPanl S _. _ . _. <br />Oaian� r. pur S __ __ _ <br />GIY Zip <br />- _ _ _ _.. ._.. <br />Ci�y _.._.___._II"_."'_ <br />Altach lour 141 copies ol plans lor proposed wo�k - prav. to scale t ntl nole �he tollo�.vmg as apPhcable�. <br />• Propertv Llnes • Cenle�lme ol street <br />• Cutline and dimensions ol all e�istm� anA • Indicate North <br />proposed slructures on Ihe lot • Show any proposetl qradiny changes <br />• Exisling nnd proposed uhhties • Show meaiurement5 <br />Phonr <br />PERMIT CONDITIONS <br />1. All calls for Inspection shdll be medo 24 hrs. in advance - phone 259•$$70. <br />2. All work shall be peAormed in accordance with ihi, permit and cunenl City o� Everett Desi9n and Consiruction <br />Standards and Specilications. <br />3. Call Location Unde�ground Sernce 48 hr,. belo:e you diy. TOLL FREE NUMBER 1•800•4Z4•$bb5. <br />� 9 '/�✓i <br />/'c.�. �j��ti ,i�:'>` ,.i �.,�I�iATi� <br />ApproveA lor CanShuclion <br />D,llr <br />FiNAL WSP[CTION p:�b <br />Approved as Constructed <br />evevetl PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EveretL VJA 9920� <br />Phonc�Y59�8870 <br />%'�!��;)',�-'� <br />� � �—;� % <br />W <br />� <br />� <br />n�Nn�n�q�LCDGCMENT OF CONDITIONS <br />The undersiqned owneVaopLcant heieby a9iees to hold and save harm� <br />Iess the Cily ol Everett Irom any and all claims lor damages. cosls, <br />e�penses. or causes ol 2c�ion Ihal may anse because ot inslallahon <br />and main�enanCe ol �he �mprovBmenl of o�her nghl-obway use hpre�o <br />�PP��ed lor anA fwther ai�rees to remove same upon notice Irom the <br />Ctly anA to replacr, pu�lic proper�y dama]etl �here6y. <br />gign�lurc ol Applican� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PEIaMIT IS ISSUED AND THEf±EAFTER IS TO <br />BE OIUG[NTLY PURSUED 70 COMPLETION. 7HIS PERMIT MAV BE <br />CANC[LL[D BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PI70JECT OVER 90 DAVS DUR�TION <br />