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Date_.;/ '_89 <br />Appiiwllon For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />Des�nbe Proposed Work <br />� % U tit <br />Prole�� Adtlress lil knOwnl <br />MaiPn9 Atltlress <br />Mailing Adtlress <br />T S�% <br />� �T <br />� T,?Ail i'/�. <br />Attach four I41 copies ol plans lor proposr.d work �'Draw to scale and note the lollowing as applicable: <br />• PraPer�Y Lines <br />• OuiGne and dlmensions ol all exisling and <br />proposed struciures on the lo! <br />• Exishng and propo5ed utilM1ies <br />a„m�cwo�xsve,mn. �// �_.��� <br />g10g OeO�� • <br />Puohc wo��s vcc <br />TON�fp� 5 — -� <br />LP55 Ff.LI Fof V2�.4 S <br />eaiao-,• o�,: 5 /1/d Cf�i%2G,� <br />• Genterline of street <br />• Indicate Nonh <br />• Show any proposed gradinc� changes <br />• Show measurements <br />LINE <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />i. All calls tor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accerdance with this pe�mit and current City of Everelt Design and Construction <br />Standards and Specilicationo. <br />3. Call Lccation Under�round Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•555�. <br />�ov�rc.�C ,.-(.'c��L[�-c� �4ro� �` <br />��,�t.�. � �2Rr�,wz�l,/ dUC. ,�O <br />�`d �-� 9�ae/� 9 _ <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�.����.�� PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8�10 <br />, � <br />./ , s � , <br />ACKNOWLEDG[MENT OF CONDITIONS <br />� <br />O <br />r <br />Y/ <br />O <br />a <br />The undersigneA owner/applicant hereby agrees to hold and save harm- <br />less the Gty of Everett Irom any and all claims tor tlamagca costs. <br />expenses. or causes of action tha� may arise because ol installalion <br />and maintenance ol thc �,nprovement or other nghboFway use hereto <br />applied lor and lurther zgrees to remove same upon notice Irom the <br />City and to replace public propeny dameged thereby. <br />. � n ._ <br />S�gnaiure of Applir�6nt " ` — - uaie <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CP.NGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURATICN. <br />