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.... ., _,.,_.' . <br />��'�+;•,:" � <br />� � � <br />� y <br />>H5~ <br />Hx� <br />�H� <br />� N '�l <br />C/� H <br />[+1 O � <br />OHd <br />��g <br />y�r (] <br />t"yZ <br />�yH <br />C� t7 N <br />��� <br />2Htn <br />HO(n <br />T -- <br />a <br />, r: ,,, <br />Date�9J9II <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />VuOhc WorFs Perm�l • <br />omg ocn� • �5�� <br />Pu��icWoitigfee $ <br />ToiN fcc <br />Le:.s ApO� Fnc Pari1 5 <br />o,i,�« o„� S <br />I <br />Jeff Pcllock 1215 Pinkerton Ave E�rerr�tt 9fl203 353-Q340 <br />Qw�e� Mailing Address Clty Zip Phone i <br />Owner <br />Mnilmy Address <br />Describe Proposed Work <br />Project AdCress lil known) <br />Phone <br />Attach lour (�) copies ol plans �or proposed work - Draw lo scale and note the lollowing as appGcable�. <br />• Property Lines • Cenledine of strcet <br />• Outlme and dimensions of all ezlsting and • Indicate No�th <br />pwposed strucW res on the lot • Shov+ any proposed �radln9 changes <br />• Existing and proposed utilities • SP,o�a measuremeNs <br />LINE <br />PERMITCONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance wi�h this permit and currPnt City of Eeerett Uesign and Conslruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-$00•424•5555. <br />�,(y� �i�%/-�., �:;�•:.. r /(/C'�� ��-f'lj�l� � �.�, <br />l <br />Approvetl for Cansiruction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />evciett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />�% �i-r..ri t <br />� • /G� -i<�, <br />W <br />H <br />� <br />N <br />L� <br />ACKNOWLEDGEMENT Of CONDITIONS <br />The undersi9ned ownedapplicant hereby agrees lo hold and save harm- <br />less the City of Everett irom any anA all claims for dama9es, costs. <br />expenses, or causes ot action Ihat may arise 6ecause ol inslallation <br />and mainlenance of ihe improvement or other n9hi�ol�way use here�o <br />apUlied lor and lurthcr aprees to remove same upon notice Irom the <br />Cify and to replace public properry dama9ed ihereby. <br />Si9nature ol Applic.^.nt Date <br />WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PER�91T IS ISSUED AND THEREAFTER IS TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED OY fHE CIiY UPON �NY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />