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Oate� <br />s�tir -,o i�srKU <br />�'- 8- `�� <br />Application Fo: <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />AppGcant <br />Descnbe Proposed Work <br />Prolect Address lit known� <br />Madmg <br />Address <br />�`f.3 /- C <br />_ __ .-- -f; / '� �� I <br />Pubbc Wo�b Pe� <br />BmB Deo� • � <br />P�e�2 wor1. fee S <br />TOtAI i!P � <br />Less>na� FncPa�a $ - <br />eaianceoue S �G� - <br />Phone <br />Cdy Zin Phone <br />Atlach tour 141 copie5 oi plans lor proposed wo�k - Draw t0 5cale and note ihe following as applicable: <br />• Properry Lines • Centerline ot street <br />� Outl�ne and dimensions ol all ezisling and • Indicate North <br />propose� strudures on ine lot • Show any proposed grading chanqes <br />• Exist�ng and proposed utilAies • Show measurements <br />PERMIT CONDITIONS <br />7. All calls lor inspection shall be made 24 hrs. in advan.e - phone 259•8810. <br />2. All work sha�l be peAormed in accordance with lhis permit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />. � � . • � -�. . <br />�, , �liZ'7� �1'/?kGv�. .��Ci-(C' �u' � � "' �02��7a !LL"2Ca >> <br />14.��� ���Wc ,�' .lLa.,a�% �lL.,K 2 X�7A�7 /o.� �_�, '�� <br />� <br />Approved �or <br />FNfJiL INSPLCTIOIJ <br />Approved as Consiructed <br />��e�p�� PUBLIC WORKS DEPARTMENT <br />� 3200Ceda;Street <br />Everetl, WA 99201 <br />Phone:259-8010 <br />Jr�� /� <br />Date <br />/- f- 90 <br />ACKNOWIEDG[M[NT OF CONDITIONS <br />7he undersigned owner/applicaM hereby ag�ees to hold and save harm� <br />less the City of Evere�l Irom any and all claims lor damages, cosis. <br />expenses, or causes ol action ihat may arise broause ol installation <br />and maintenance ol the improvemenl or other rlght�ol�way use herelo <br />applied for end furiher agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />i <br />/il,-� ��»��-�--i�a�� �t�-a- �� t. �-�� �� <br />Signalure ol Applicant . Date <br />WORK AUTHORIZED BY THIS PERMI MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEAMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />