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� L�/ J <br />ay <br />m�x <br />a�am <br />H �� <br />� H� <br />�N� <br />V1 H <br />y C3 <br />� O L�1 <br />H C7 <br />O H�y <br />HMO <br />G� � C� <br />�H� <br />HH <br />g�' <br />H <br />C7 C p� <br />��r <br />[�1 <br />H O C�a <br />Date 1/3� /91 <br />Application For <br />PJBLIC WORK� PERMIT <br />Print or Type Only <br />TO pn�T��,af �-�s-�3 <br />PUDI¢ Wo�ks Permn a <br />B�Cg.Oept.a 91/�1.3�J� _ <br />Publlf. \YO�kS FCC �n <br />TOldl FCC `� <br />�ess nooi. Fa� Pa�a S <br />oaiance oue 5 <br />Ptir,jy�e� H�dsn th tana ea �' cr Everett, WA 98203 353-2823 <br />Owner Mailing Adtlress City Zip Phone <br />Describe Proposed Work <br />Projecl Address lif known) <br />�dailinq AAdress <br />1809 Madison <br />City Z�p <br />Attach lour (41 copies ol plans lor proposetl work � D�a:: to scaie and no:e Ihe lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline antl dimensions ol all enisting and • Indicale Nor�h <br />proposed siructures on the Ioi • Shcw any proposeA 9radin9 r.hanges <br />• Fxisting a��d proposed utilities • Show measurements <br />� PERMIT CONDITIONS <br />1. All CaIIS fOf inspeC�iOn Shall be made 24 hrs. in adv0nce- phOne 2�J9'88� a� <br />� w 2. All work shall be pedormed in accordance wilh this permit and current City of f_veretl Desi�r �nd Construdion <br />Standartls and Speciliwtions. <br />"'� � 3. Call Lowtion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />C��� G.��� i�.�s.u:f��,-z` .�e�«� � j> <br />, � <br />`�" `.� /Y7G"L—1 �._ <br />/ � 3/-. i/ <br />Approved lor Construction Date <br />FINAL INSPECTION <br />Appraved as Constructed <br />everett PUBLIC WORKS DEPARTMEP�'. <br />� 3200 Cedar Strcet <br />Everett WA 98201 <br />Phone:259�08�0 <br />Data <br />ACiWOWLEDG[MENT OF CONDITIONS <br />The undersic�ned owner/applicanl hereby agrees to hold and save harm� <br />less the City ol Everetl irom any and all claims lor dama9es, cosis, <br />expenses, or causes o� action that may arisa because of installation <br />and mainlenance of ihe improvement or othe� ri9h4obway use hereto <br />applied lor anA luriher a9rees to removn same upon notice from ihe <br />Cily and to replace public property dama9ed Ihereby. <br />Si�nature of Applicant Dalc� <br />WORK AUTHURIZED BP THIS PERMIT MUST BE ^TARTED WITiiIN <br />iQ0 DAYS OF ['ATE FERMIT IS ISSUEC '�ND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO GOMPL[71GN. THIS PERt?IT MAY BE <br />:'.qNCELL�:' OY THE CITY UP0�4 ANY SiGPPAGE OF WORK ON THIS <br />i'ROJECI OVER 90 DAYS D'JRl�TION. <br />