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Publlc Works Permit a ��< ���'/ <br />Date lh-I.�-y'L TO �'OSTiNG R/za/� ,�a3�� <br />eie9. oaw. • <br />- Application For <br />PUBLIC WORKS PERMIT P"°ToaFaa`aa $ <br />loss AO��. Fae Paid $ <br />a D Ou <br />. Balance Due � <br />Print or Type Only <br />Owner <br />Atldress <br />� <br />City , <br />Zip <br />DO�---�2Z`1oi/93 / <br />Phone <br />Applicant <br />Mailiny Address Ci�y Zip Phone <br />Describe Propoaed Work J�J��� I I� ��— <br />Prolect Address (if known) ' <br />Altach tour (4) copies of plans for proposed work - Draw to scale ancl note lhe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposed struct�res nn the lol <br />• Existing and proposed ulilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grrding changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259•8b10. <br />2. All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�. G�� �� L2 �o QE /ZP�6'CaGC�(� i�Ge�++/ %�LPst✓ <br />O/Lc.c.iec�'o.,� ..i�[2�tf' (� ��PiV G�,y af�.,.�an.<� �''-s'O7, <br />O 7�zco� � C�cc.aZ`cc0 �.1 /�+�'�'��'� <br />CGc26 �a�a- <br />�.��i�.� Cor.�-P�Ze. �� � g��.��.sRe��ti� no /�,z�,-��...� <br />e� s� cti�n,G, ,c� n.�'<a-u.-�rCL. <br />' /��ir-o�� /d a7 9z <br />Approved for Cons ruction ate <br />��/�---��f -- i -/7• � 3 <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />'v�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 08207 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF C04DITIONS <br />W <br />H <br />0w <br />_ i <br />� <br />O <br />�♦� <br />V♦ <br />O <br />a <br />The undersigned owner/applicant hereby agre•�s to hold and save harm� <br />less ihe City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arisn because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and turiher agrees to remove same upon notice Irom ihe <br />City and to replace public property damaged thereby. <br />f����` `�°�'-�' 'Z`z��v� <br />Signature ot Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTcD WITHIN <br />BEODI�LIGENTLY PURSUEU TOICOMPLE�TION.DTH SEPERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />