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Date_L!"� JU f GS'I eDl <br />ApPilcation For <br />�UBLIC �tVORKS F'�RMIT <br />Print or Type Only <br />Malling Address <br />�, <br />AtltlrCSS <br />Desc�ihe Proposed J�'ork <br />Proiect Address lif knownl -�' �� '�� � t <br />Attach lour (4� copies of plans for proposr.d wurk - D <br />• Property Lines <br />• Outline anc' dimensions of all existing and <br />proposed structures �n Ihe lot <br />• Existing and prOposed utilities <br />�/7� PUUecWmhsPne'' ��J.� )7 �Cr G•.. <br />n�<te. onoi.. .�S�fj__����._ . <br />I VuLI¢WorFsFco <br />lolnl Feo $ — <br />Le55 Appl FOc F'dW J��_ <br />o,i,��� o�� S.3=.'.i 3 r`__ <br />,.-, :�-4��� '���� J ���-� ���y8 <br />_.,,. , , , <br />----__..__, .:_.__._ _ <br />C�ly Z�P f Phone <br />Viry uy riwne <br />and note the to�lo�rlralj as applicable: <br />• Centerline oi street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremen�s <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in advance • phone 259-881 O. <br />2. All work shall be performed in accordance with this permit and current City o! Everett Design and Construction <br />Standards and Specifications. <br />3. Cal� Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-SCQ•����-5555. <br />� �.[_L.C� �OZ� �Ct� �G C�G���-L� �L��J C��JP�Kfl�� �-/lyt�L <br />d�.t�� 3- � -�y <br />� CO�✓ . �i�icu.� /"� 03l20/89 <br />S_ c�r�`�.�G � <br />� �/ q000^c1351 <br />�n. t�a�� 2� ELDG <br />,(j. ((,5,� CONT,eO<!�0 .1)��✓Si>� BHG,CFiLG �� �p� <br />�Q�s'ro.e,.v� E-✓�-,��,e��.v a �j- T 8.✓c�. <br />,f� ,�i�.1:, �89 <br />qpproved fo� nstruction Date <br />��� /��' ll/�%/ <br />F�NAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar Sireet <br />Everett, WA 98207 <br />Phone:259�8810 <br />9:48AM OOOFN4883 <br />� i� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages, costs. <br />expenses, or causes ot action that may arise because ot installation <br />and maintenance of tne improvement or other riqhhoi-way use hereto <br />applied for and turther agrees to remove same upon notice trom the <br />Ciry and to replace public properry damaged theieby. <br />� 5j.��%'��f'.� C�.On�iT. <br />� �.n_� <br />re of A <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. 1'HIS PeRM1T :v1AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />