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�� <br />� <br />TYPE OR PRINT ONLY <br />Applicatim Fa <br />PUBLIC WORKS PERMIT <br />Puauc wa+Ks oeaa�rr�+eNr <br />s2oo cem, s��+ <br />Everett. WA98201 259-8810 <br />� � QOSTING �UN 1 5 198A <br />�g <br />� ti� <br />�ta �� /��i � — <br />�,a� �n • �(� . <br />ewa�� a�n x r? (v 3( 5 <br />P�+SL�� W4rks Fee S / ' <br />LP a <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />/�VG <br />Phone <br />Attech four (4) copbs of plans for proposed wak - Draw to scale end note the folbwing H appliceble: <br />'Property linas 'Outline and dfinensbns ot all ezisting ard proposed structures on the bt 'Existing and proposed utilftles <br />`CentMine of st�eet 'Indf :ate North 'Show a�y poposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be madb 24 hours in advance - phone 259-8810. <br />2. PJI work shall be performed in accordance with this permit and curtent City of Everett Design and <br />Construction Standards and Speciflcations. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-124-5566. <br />�� �0 Q` �'tGPln�bn [.7f T.���G�. ��'i•c�G <br />-�raNs� �-ian �a � I lt,� 9rt,dc vnosk <br />W � ( � �tC. �.�'►'� i t,'�t.�.. <br />OCL+ur c�n '�'�► i S � o}, <br />�. �py�,� 5;��� ►���� ���� ►��,��+�� <br />U PL. w� s;d�sc„�cr- ; s u��� nec� s-1-r'�ctm, <br />�a rw ,� oe� Z1--'--'— <br />_� �/•�� /2 -fi J <br />4MAL INSPE� �N Dete <br />Approved as Constructed <br />ACKNON/LEDfiEMENT OF CONDITIONS <br />The undersqned owner/epplicanl hxeby aprees to hold and seve harrt�lesa <br />tM Cky of Everott hom any and all clNms fa dunspes, costn� ezpenxs� a <br />ceuaes of actbn thal may a�ise becaime of Inshllatla� end malntenencx of <br />the impovert�ent a other rlyht-of-wey use he�Mo aPPMed tarand hMher episss <br />to renave same u{an ratice hom the CiIY and to replace P�� PrM�Y <br />dart�eped therobY• <br />��- r�-.�� 9-4-9� <br />Signature ol Appl�ant <br />WORK AUTHJRIZED BY THIS PERMR MUST BE STAHTED WfTHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFTER IS TO BE DI:JOENTLV R�RSUED TO <br />CAMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CRY UPON ANY STOPPAOE OF WORK ON 7HIS PROJECT OVER 90 DAYS IXIMTION. <br />