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Date.1��_ O i� <br />Applica�inn For <br />PUBLIC VI/�RKS PERMIT <br />Print or Type Only <br />��y <br />Fpplir_aN <br />hny <br />fdailin� Addross <br />c�;� z�� <br />Desc�ibe Proposed 6York .� � ?���,� <br />i <br />��oiect Address (il knownl <br />n.,oi.� c,o�ns r,..,����i <br />ei�9 Depl <br />,, ��� , <br />Punhc worYs Fec <br />iolal FP.p S <br />lessApUl FnrVa�a �u-_-%� <br />e�,nre000 5 � <br />�iP Phane <br />Attach four (n) copies ot plans lor F�oposed work � D�aW lo scalP antl note Ihe following a� apphr�Ule: <br />• Property Lines <br />• Outlin= and dimensions �t all exi;ting antl <br />proposetl struciwes on th-� bt <br />P cxishny and proposed utih:ies <br />• Centerline of street <br />• Indicate North <br />• Show an,� proposed yradicg changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - nhone 259-D810. <br />2. All work shall be per�o•med in accordance wilh this permit and curreM City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Undergro�nd Service 4� hrs. before you dig. TOLL FREE NUMBER 1-500•424•5555. <br />�YC7 ��!,C/�/GJ���_ PC�/,+')%% ���1!/��",C� <br />i= Gf�ll� � <br />J�._ .� � S C-�1%2/�7 �• —__�/,,GE �'/�"%/r: <br />//'�<i , i � 1.-`� _.. <br />�� , .:-- . <br />ApProved lor Cor struction <br />FINAL INSPECTIOIJ <br />Approved as Gnnstr�cted <br />everelt PUBLIC WORKS D[PARTMENT <br />� 3200 Cetlar Sire�+t <br />EveretL W4 99201 <br />Phone:£59-8910 <br />CNOVJLEDGEMENT OF CONDITIONS <br />W <br />� <br />sw <br />_/ <br />The undcrsigred ownedapp6cant heieUy a9rees to hold:md save hann- <br />--- �less !he City of Evareit Irom any and all claims lor damages, costs. <br />expenses or causes ef action that may arise 6ecause of installation <br />' anA main�enance or Ihe im�rc+ement or othe� rigM-ohway use hereto <br />--- ipnli��1 icr dnd further nnrees to remove same upon notice Irom ihe <br />D'3'.P C�ty and Io iePlace public p�on�i�y dnm�getl �hereby. <br />Uate <br />Siqnalu�e ni ApPI1Cdn� Da�e <br />WORK AUTHORIZED BY THIS PERMf( A1UST E3c :�TARTeD WITHIN <br />180 DAYS OF DATE FERMiT IS ISSUED AND THEREAF�ER IS TO <br />BE DILIG[NT:Y PURSUED TO COMPIETION. THIS PERMIT MAY BE <br />CANC[I LCD BY THE CITY UPON ANY STOPPP.GE OF WORK ON THIS <br />PROJECT OVER 30 DAYS DURA710N. <br />