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DateS/Zy/ Fq <br />, , <br />. Applica�icn Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />L <br />Mailing Atltlre55 <br />Describe Proposed Work � u i l� /� r�_�O <br />Prolec� AAdress (if known) <br />, <br />Put��.c Wc•ss Par[m�i� . � — �C�� <br />�ing OePi . _6 y �p�C�_�_� '_ _ <br />— �. <br />hc Wor.s �en <br />Total Fre S <br />1e55 AOoI Fep Vrid S�__ <br />BaianceDun s ��� <br />t�p Phone <br />Attech four (4) copies of plans for proposr.d work - Draw to scale and note ihe lollowing as aPplicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposetl structures on the lot <br />• Existing and proposed ulillties <br />� Centedine of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremerts <br />PERMIT CONOITIONS <br />1. All cells for Inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shell be peMormed in accordence with this permit and current Cily ol Evr:rett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />��-? ��i'-C`/ 2 (l -s-� <br />Approved lor Construc � / Date <br />.C� /�— ��- � � �j <br />fINAL INSPECTION Date <br />Approved as Construcled <br />everett PUBLIC WOFKS DEPARTIdENT <br />� 3200 Cedar Street <br />Everett WA 99201 <br />Phone:259•8810 <br />05/14/89 10:53AM OOOpqb312 <br />W <br />� <br />� <br />i4000�2�6� �� <br />ELDG 4108.OQ <br />E SRCH 83.50 <br />ACKNOWLED� 11�,NT OF�',`�1�TIONS <br />The undersigned owner/appliE�iPereby�es�-(y hold and save harm� <br />less the Gry of Everett Irom any and all claims lor damages. cosis. <br />ezpenses. or causes ol action that may arise because ol installation <br />and maintenance ol �he improvemenl or other nghrol-way use hereto <br />applh�d lor and lurther agrces tp remove same upon noUce from ihe <br />City and to replace pubhc property damaged Ihereby. <br />+�.�n�.cf��u � Co i `i � <br />Sic�nature o Applicant �'j��� Date <br />WOPK AUTNORIZED EtY THIS PERMIT MUS BE START D WITHIN <br />180 DAYS OF DATE FERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUEO TO COMPLETION. THIS PERMIT MAY dE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DA1'S DURATION. <br />