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� H <br />ta <br />m <br />b � <br />b H f~!1 <br />y <br />K n <br />H X1 <br />O tl O <br />"-0 H �U <br />N N�'" <br />� H O <br />O 1-� <br />a n u <br />H M O <br />�• n <br />N C <br />�Z' H T, <br />C�� y Z <br />�Q7 N y <br />!7 C N <br />�°ar <br />2 H N <br />H O U7 <br />n-7 <br />Date �_r %� <br />qppliCalio� For <br />PUBLIC W'(�E��S PE�MIT <br />Print or Type Only <br />��•'`�'• P11t11�[ l'IOrks PL`Im�il��/7 7T %%�y/�- <br />G�nn Den� • __�1_�"`- �Lt�:^!< - <br />PuLhr.v:nncFec 5 <br />imnl Frc <br />tessnno� Far n:��n S <br />Bxinnrc Oua � <br />������ Ci�Y Z�P Phone <br />ApP�i�_�� M�iling Address <br />�sscnbe PraPcsed bVork �' \ � / �+"-'-`� <br />Proiect Address (il hnown! � � vr -t++—.�--t-�—�v- <br />ol lans �or prop05ed work � Drav: to ScalC and no�e �he lollowing <br />Attachfour�41 copies P <br />• Properry Lines <br />• Outline and dimansion, of all ezisting ;ind <br />proposed structures on the lol <br />• Eaistin9 and pruPased �tililies <br />• CeNedine ol street <br />• Indicale North <br />• Show any proposed grading changes <br />• Shov+measuremeMs <br />j'� ���4 PERMIT CON�ITIONS <br />_� �� 1. All calls tor inspection shall be made 24 hrs. in advance � phone 259•8810. <br />. 2. All u•ork shall be pedormed in accordance wilh ihis permit and current City of Evere�l Desi9n and Construction <br />� Standards and Sped�ications. <br />� 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBFR 1•SOG424-5555. <br />l'1L�T ��C-� . <br />`�1,C''�.� <br />App�oved for Construction Date <br />FINAL INSPECTION bate <br />Approvod a5 Conslructed <br />everett PUL3LICWORKSDEPARTtdENT <br />� 3200GedarStreet <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />L� <br />Tne undersigned owner/apPlicant hereby agrees to hold and save hann- <br />less the City of Everet� from any and all claims for damages, costs. <br />ezpenses, or causes ol action that may arise because ol installa�ion <br />and maintenance ol the improvemenl or othe� right-ol�way use herelo <br />a{:plied for and lurther a9rees b remove same upon noticn irom iha <br />City and to �eplace public property damaged ihereby. <br />Sipnature ol Applicant Cate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARfED vVITHIN <br />190 DAYS OF DATE PERMIT !S ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br />CANCELLFD BY THE CITY UPGN AIJY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS JURATION. <br />