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Date��t�� ! � <br />Application For <br />PUBLIC WORKS P�RIVIIT <br />Print or Type Only <br />v � r. <br />Applicanl <br />Describa Proposed Work <br />Project Addre��- ;il known� <br />sv�Z S� ,5�� <br />Address <br />c��v <br />��-��� <br />Public Woik! Parm11 <br />Blap OBpt M _ ������ <br />r�ei�c wo�as Fco � <br />Tolol Faa — <br />Les.AOPI. Fea Pai� S _ <br />o,�,�«o�� s 35�`� <br />� <br />Atlach four (4) copies ol plans for proposed work • Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline cl sireet <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed struclures on the lot • Show any prvFosed gradiny changes <br />• Existing end proposed utilities • Show measuremeMs <br />PERMIT CO^DI'i IONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•88�5 5. <br />2. All work shall be perform=d in accordance with ihis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 48 hrs. before you diq. TOLL FREE NUMBER 1-800•424-5555. <br />y; %p 6'� C�it7ST2U�7E'O f E� i��i�/�D✓�� <br />/'�LoT .�c'�nJ v9r�'Q G�S/86 <br />`� pW,U�2 TO P.�OI�/OE fi /�E.e/'r,�rnq�/C�' (�Uq.2(9�r/Ty <br />�� T•t/E � � �' Cuiz,3� G.:•rrE.e /,�yo <br />S%OEulf�L.0 �%S /S T INSTALL AGOy� lvlfJ,Q/L�//d AI�E, O.E.' <br />SiG•�/ .9 PE. �T�oN F�2 A GOCqt TMP.Pd✓ErnEn/T �/ST�/L7 <br />,1�� �v�y �=�/p8la 0.2 A STo.F''W02.t 020E2 Gt/iGL <br />BE Pc 9GEO � Ti,rE C'.�oTEc i, <br />FINAL INSPECTIG�J <br />Approved as Construcled <br />r•�erett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 58201 <br />Phone: 259-A815 <br />Date <br />W <br />H <br />� <br />� <br />i <br />� <br />O <br />a <br />hCKNOINLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herety agrees to hold and save harm- <br />less ihe City oi Everett irom any and all claims (or damages. costs, <br />expenses, or causes of aclion that may arise because of installation <br />and maintenance of the imorovement or other right-of-way use hereto <br />applied fo nd furiher agrees to remove same upon notice trom the <br />City a to r place ublic property damagetl there <br />, �� � ��.� � /' , �� � <br />S' ture u A� pliCant � � Dule � <br />ORK AUTHORIZED BY THIS PERMIT Qi1/b5T BE STAR'rED W�THIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILI6ENTLY PURSUED TO COMPLETION. TH13 PERMII' �+1AY BE <br />CANCELLED B'f THE CITV UPON ANY STOPPAGE OF WOf7K ON TNIS <br />PROJECT OVER 90 DAYS DURATION. <br />