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oateL-�90 <br />Applicetion Fn� <br />PUBLIC WORKS PERMIT <br />Prfnt or Type Gnly <br />Adtlress <br />��r1 <br />Describe Propoaed Work � <br />Pro�ecl Addreae pf known) <br />J-1-�'4- <br />TO POSTIhG_ �i� z= <br />V�IY Zip <br />4ttach tour (4) coples of plana lor proposed work - Drew lo scale end note the lo�lowinp ae applicable: <br />� Proporty Linee <br />• Outline and dimensiona of all axisting and <br />prOposed atructutes on the IOt <br />• Exlsting and proposed ulilitles <br />PueLc Wor�� Permn � ___ ��l�/�.� � <br />Nlea Oeo� � �! �% G+ 7... �' <br />PubLt Wor4� fee <br />Tolel iea ' <br />Len �oo�. reo Pue { <br />e.i.�« r�� a �d ou <br />• CeNr.rlino ol streel <br />� Indicate Norih <br />• Show any proposed grading changas . <br />• Show measutemen�s <br />PERMITCONDITIONS Ol/02/91 10�57AM OOOAN5113 <br />1. All calle lor inapectlon ehell be made 24 hrs. in advence - phone 259•8810. / <br />2. All work ahall be pertormed in accordance wlth thla permit and wrrent City ol Everett Deslg2tndCypetructlon <br />Standarde end Spacillcallona. IIU�025Yll <br />3. Call Locatlon Underground Service 48 hre. before you dlp. TOLL FREE NUMBER 1-8b(ii2{�5558545.0[1 <br />PLBG t55.tK'i <br />MECH f11D.00 <br />4.ANY CHANaB IN THE URIVfiWAY CUT MUST BS APPROVBD d SRCH f4.50 <br />BY TH6 PUHLI� WORRS INSPBCTOR. DRUW s20.00 <br />5.CONNBCT DOWNSPOUTS TO PUSLIC DRAINAGS SYSTSM. HW028036 <br />8. KHSP CITY STRSHTS CLSAN AT ALG TIMSS. SEWER s30•00 <br />7.ANY PAMAGI3 TO TH6 CURB AND SIDRWALK WILL B6 RfiPAIRSD 1171-5 f813.00 <br />TO THE SATISFACTION OF THB P(iBLIC WORKS DEPT. MOOOU7086 <br />WiTER 1108.00 <br />IIRIER V-lO8.IX1 <br />�� ,��.� <br />�� s��z.� <br />�' �� r✓_l��-�. 1 I- l(.R-90 <br />Approved lor Conslruc ' n Dale <br />�G��� %—/ 9- 9/ <br />FINAL INSPECTION Date <br />approvnd ae Conslructed <br />everr.tt PUBLIC WOPK3 DEPARTMENT <br />� 3200 Cetlar Stree� <br />Everetl, WA 98201 <br />Phone: 258�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />• � <br />W <br />H <br />� <br />ihe undersigned owner/applicani herebyagrees to hold end 5avo harm• <br />less the City ol Everetl Irom any and all clalms for dame�es, cosls, <br />e�penses, or causes ol aclion that may erise because ol installetion <br />end meinlenanca ol Ihe improvement or other right•ol•way use hereto <br />applied �or d 1 ther a es fo remove same upon notica from tha <br />Cily and epl e publ' rOperly dameged thereby <br />Signature of Applican� Date <br />WORK hUTHORI2E� BV �HIS PERMI7 MUS'i BE STARTED WITHIN <br />1B0 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ThIIS <br />PROJECT OVER 90 DAYS DUHAT�ON. <br />