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Uate���Js <br />APplicallon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />J�wt-� �.���- lzi� / <br />Ownei �\9adin.; q�,dress <br />Z�n <br />�11. <br />AP?licant Mr�qi�r.; � <br />�ddiess <br />p QQ � <br />a.,e��v:o.�.o.,�,�i. —/.S! i �o <br />9inq ocn , <br />Put�hp YJarxs Fce ---- <br />iolpl ip= 5 <br />Lu554pp1 Gnrv Fai�� �j <br />o.,i,��.�, o�� 5 v��� <br />-----_------ <br />� <br />� <br />/ Phone -----�- <br />Describe Pro , /�� ' � <br />Pcsed Work _ �G- - �...'_..(�1��_ � _��'yr��L.-�.���� <br />� L �---r��-° - X�so_t_o_.�no_ � y �_ __ <br />Project Atldress (if knnwnl <br />At�ach low �4� coples of pl�ns foi pmposed wurk - Drav.� to >� ,�iv ,ini n,-�r, p�„ foqr,wing as anUhc�blp: <br />'� P�oPerty Lines <br />�` Ouiline antl Almensions o( all exishnq and <br />P��Posetl structures on the loi <br />� Existinc� end proposed utilities <br />• CeMerlinr nl sireet <br />• I�•,dicate Nor�h <br />� ShoW any r,reposetl �radinq chan�ns <br />• Show mrasuremeMs <br />�� �.�� .vnii¢ ntLuw IHIS LINE <br />PERMIT CONDITIONS <br />2. All wo�k sha I be pe'rfo nhed n accordancerwith th s perm��and c�59'88�0f Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dic�. TOLL FREE NUMBFR 1-$00-q2q.5555. <br />W <br />� <br />� <br />� <br />�� <br />� <br />7� �e� t%�y Sfr��-f CLe�n a� �Cl ���e,. � <br />O <br />�� <br />_-_-_-_ _._—_� <br />, �.� �_ ���s- I <br />Approved for Cons tipn. � �, <br />I <br />i ,- <br />�-�:-� �-17'J�_; <br />F'.NAL I S CTION ; <br />Approved as Construcfed ��« � <br />PUBLIC WORKS DEPARTMENT <br />3200 CedzrStreet <br />Everett, WA 98201 <br />Phone:259�8810 <br />♦rA <br />V♦ <br />O <br />a <br />ACKNOWLEDGEPdENT OF CONDITIONS <br />ihe undersiqnetl ouvneNepplicant hereLy agrees �o holtl and save harm- <br />less ihe Qty o� Evarel� trom �ny antl ,all claiins for tlamages. ,;p5�s. <br />p.xpenses. or CauSes O� aClion that may anse be[ause of inSlallation <br />and main�enanr,e of Ihp improvement or other right�of-way use herelo <br />��;n��^d lo� and further aqrees to remove samn iipon notice irom the <br />C�'y,�rr to rnPla e pubhc proneny damaged thereUy. <br />-���� G� V���s <br />Siyna�uie ol Applican! Ua <br />IVORK AUTHORIZED BY THIS PEHMIT MUST BE STARTED WI�HIN <br />7H0 DHVS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdqY 6E <br />C4NCELLtD BY THE CITY UPON ANl' STOPPAGE OF WORK CN THIS <br />P�7p.lEC;T OVElt 90 DAVS UURATION. <br />