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��"' <br />Q � <br />��� <br />R�� <br />��� <br />OM <br />� � <br />is` <br />L� � <br />hh <br />G <br />� � <br />�� <br />��1 <br />��' <br />� �� <br />� � <br />Date��� <br />Aoplicnlion Far <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ny <br />TO FbS�'ING 1-l- s -� �__ <br />Sppji�i,P hlalbny Atldress <br />Descnhe Proposed Work <br />Prolec� Address lil knownl <br />Ciiy <br />PV�hc Wo�hP Pp�md (•� �[1�I ll��C[` <br />Di�19 DUPt � d �/ �c+Z (.l. <br />P imic works Fec <br />ro�,� F�� 5 — --- <br />Il'16P111�1�9CV�.\it15 on �� ��� <br />o,ia����• o�0 5 _e� _ <br />Lp Phone <br />Attach four I4) copies of plans ior proposed wo�k � Draw lo sc�le and note the tollowinq as applicable� <br />• Property Lmes • Cenler'me of streel <br />• Outline and dimension5 0l ail existing antl • Indic:,la Norlh <br />prOposed structures on Ihe lot • Show any prOposed 9rading changes <br />• Existing and proposed utilities • Show measurements <br />FINAL INSF'I <br />Approved as <br />evecett <br />e <br />LINE <br />PERMIT CONDITIONS <br />1. All calls �or inspection shall be made 24 hrs. in advance - phone 259-5810. <br />2. All work shall be pedormed in accordance wilh this permit and cwren! Cily of Everett Design and Constmction <br />Standards and Specilications. <br />3 Call Location Untlerground Service 48 hrs. belore you dic�. TOLL FHEE NUMBER 1•800-424•5555. <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, VJA 98201 <br />Phone:259�8810 <br />/ /9-89 <br />Date <br />� <br />ACK�OWLEDGEM[NT OF CONDITIONS <br />W <br />H <br />_ / <br />� I <br />O <br />The undersiqned o�vnedapplicant hereUy:�c�rees to hold and save harm- <br />less the Clty ol Everetl Irom any and all claims lor damages. costs, <br />expenses. or causes ol aetion Ihal may arise because ol in, allatlon <br />and maintenance of the improvemenl or olher right-ol-way use herelo <br />applied lor and lurther agrees to remove same upon notice Iwm ihe <br />City 2nd to replac cblic roperly damaged therehy. <br />l�� f �Z'S�'l <br />gnalure ol AppliCan� �— <br />WORK AU'HORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAY;� OF DATE PcfiMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGFNfLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE r,iTY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS UURATION. <br />i ' <br />