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� � <br />��� <br />i�tA <br />►i � <br />�0�� <br />tA <br />xo <br />� M d <br />�� <br />4�-1• <br />Z M <br />H <br />IN ► <br />�a M <br />W � <br />�� <br />� <br />Date � 90 TO POSTlNG_� zs� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pon�.cWm�aPr,mn. o�/jci�1 _ <br />eiea o�o�� • 90/24892 <br />Puobc worAs �ce 5 <br />Totni Fea <br />LlSs �p0� Fe! PdW S <br />Baiance Duo S Z� <br />Oime7C Phone <br />qpplic0ni Mailing 4ddress C��Y Z�P <br />Describe Proposed Work <br />Projer.t Address lil known) 4� ' 'r�^^ <br />Altach lour (4) cop�es of pl�ns for proposed work • Draei to sca'^ anG n�te Ihe lollowing as applicable�. <br />• PrOperty Lines • CeNerline ol slreel <br />• Outline and dimensions ot all eaisting antl • Ind�cate Nort� <br />proposed StruCWreS on �he b� • Show any pwposed g�ading changes <br />• Existinq and proPosed utilities • Show measurements <br />� PERMIT CONDITIONS <br />��� . 1. All cells lor inspection s�all be made 24 hrs. in edvance - phonn ZS�8810. <br />2. All work shell be peAormed In accordence with this permit and current City of Everelt Design and Construction <br />Standards and Speci'icetiona <br />' 3. Cell Location Underground Service 48 hrs. belore you tlig. TOLL FREE NUMBER 1-800-424•55$5. <br />i �� <br />��� <br />A.ANY CHANGB IN THE DRIVHWAY CUT MUST BE APPROVED <br />gy THg PUBLIC WORHS INSPHCTl1R. <br />5.TIGHT LINS DOFiNSPOUTS TO SID$ S$WER. <br />6.KfiSP CITY STREfiTS CLEAN AT ALL TIMfiS. <br />7 TO THfi SATISFACTIGNUOF THE PUBxLW7CLWORKSLDSPTREPAIRED <br />��GC�.,--� i�'� �' �� 8 % -- 9O <br />Approved lor Constru 1Jon _ Date <br />��% �=-- <br />=1NAL INSPEf.', ION Date <br />qpprovetl as Gqns'.�ucted <br />evr�en PUBLIC WORKS DEPARTMENT <br />� �2G0 Ceder Stree� <br />Everett, WA 98207 <br />Phone: 259-8810 <br />ACKNOYJLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The unde�signed owner/applicanl hereby agrees to hold and save harm- <br />less tne Clty ot Everett Iwm any antl all claims lor damages, cosls, <br />expenses, or causes ol aclion Ihat may arise because ol instaUation <br />and maiMenance ol Ihe improvement or o�her ri9hFof�way use he�e�o <br />applied lor and turthei agrees to removc same upon notice Irom the <br />Cily antl to rep�ace pu6lic property dama9ed Ihereby. <br />Signalure of ApP�icam �- -- <br />WORK AUTHORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERfd1T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERhUT MAY BE <br />CANC'cLLED BY THE CITY UPON AN'f STOPPAGE OF WOPK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />