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HC�� <br />A xl pC <br />C. H <br />9HN <br />H�� <br />�H7�a <br />� � � <br />fA H <br />�i <br />� � ] h <br />OH <br />��g <br />�. � <br />t�y� <br />HH <br />N <br />gd� <br />� <br />H� <br />HON <br />Date 6 z� s% <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�� <br />i�S�-.d �Qo3 � �Z�C <br />LA.�./J' ` O'� J i <br />Applicant <br />Describe Proposed Work <br />Moiling Atltlress ���Y <br />C.o. P U. Boz 9Sf:' {V E-/l�s71" <br />Mailing Address ���Y <br />Prolect Address (il known) _ �2 � `S� . �'�/�2E77 �%aL C G�//i?� <br />� PubLc Wo�Ms Purmlt • <br />oia9. oeo� • — <br />Pubiic Woika Fca � <br />Totnl Fce <br />LcesPpo� Foe Pn� <br />Balancu0uo S <br />p Phone <br />%yzoG ZSi-9/�% <br />LIP rnona <br />At�ach four (4) copies ol plans lor proposed work - Draw to scale antl note ihe lollowinc� as applicable: <br />• Property LinPs .• Cenledine of street <br />• Outline and dimensions of all ezisting and • Indicate Norih <br />pwposed structures on ihe lol • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PEHMIT CONDITiONS <br />I. All calls lor inspeclion shall be made 24 hrs. in advance - phone 259•88� 5. <br />2. All work shall be performed in accordance with this permit ani current City ol Everett Desi�n and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUM�ER 1•800•424-5555. <br />y C cX fj j— /110�/,'7c/'�i �C� % f' �,' n% / �-' � <br />' /�.E'.� f �= �'�� �G.�jn,l.l'T �'��'� �O�_ <br />�o <br />FINALINSPtUIiUN �-' <br />Approved as Conslructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phonr.259�8815 <br />�� � <br />��, <br />Wi <br />E- I <br />��w ' <br />_ / I <br />� <br />Q <br />ACKNOWL[DGEMENT OF CONDITIONS <br />Thc undersigned owner/applicant hereby a9rees ta hold and save harm- <br />less the City of Everetl Irom any and all claims lor damages, costs. <br />expenses. or causes ol action ihat may arise Uecause of installation <br />and main�onance of �he impwvement or other righPo4way use nereto <br />applied for and lurther agrees to remove same upon notice from the <br />City and to replace public property dama9ed lhere6y. <br />� �� 6 /zz/��'7 <br />Signa ura of Applican� —T��a�e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />190 DAYS OF DATE PFRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMP�ETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER �JO DAYS DURATION. <br />