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�i i=i � <br />��x <br />C H <br />>HxV� <br />H Z� <br />� H� <br />"�9 H';1 <br />VJ H <br />Cs1 O � <br />�3 <br />�/��g <br />y�Y � <br />z}.y� <br />rHH <br />gN <br />❑d� <br />[+1 � Crs1 <br />HOti <br />11/8/91 <br />Dale «tiar� <br />AOP�icalion For <br />PUBLJC WiDRKS PERMIT <br />Print or Type Only <br />�.�PuO��clYo�hsPmmit• <br />e�aa o.Fi • 91/28092 <br />Pubucworxppon S <br />TOlal Fea <br />Less Aopl Fee PaiJ 5 <br />oaiancr ouc � <br />Port of Gverett PO Box 538 �verett 98206 259-31G4 <br />Owner MailingAddress City Zin Phone <br />Address City <br />Describe Proposed Work Construrr OOOcf c 1 h�il ding <br />Pwiect Address lif knownl <br />Atlach lour (4) [op�es ol plan5 for proposed work � Draw lo scale antl note �he lollowing as applicabl¢ <br />• Property Lines • Centerline ol street <br />• O�tline and dimensions of all exi5ting and • Indicate North <br />propo5ed Sifu[ture5 on lhC lot • Show any prOpoSed grading Chan�es <br />• Existing and proposed util�hes • Show measurements <br />ti <br />� PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advanca • ohone 259•8810. <br />2. All work shall be pedormed m accoidance with this permit and currenl City o! Everett Desipn and Cunstruction <br />fe � Standards and Specilications. <br />�. � 3. Call Location Undergrountl Service 48 hrs. belore yc u dig. TOI .. FREE NUMBER 1•800•424-5555. <br />U�G� + � 7 % <br />l�loz/'^.� ��� /c%�J� /-P�ccc�'�G <br />�� <br />/2 �/n -9i <br />Approved for Construclion Date <br />FINAL INSPECTION <br />Approved as Conslructed <br />��f���-111� PUBLIC WORKS DEPARTMENT <br />�—`� � { 3200 Cetlar StrCel <br />�� EvereU,WA98201 <br />Phone:259�8810 <br />Dale <br />ACKNOWLED�EMENT OF CONDITIONS <br />� <br />O <br />� <br />Y / <br />O <br />a <br />The undersigned owner/applicanl heraby a9�ees Io hold and save hanm <br />less Ihe Cily ol [verett Irom any and all claims lor dama9es, cos�;. <br />expenses, or causes of actwn that mny arise because ol ins�allalion <br />and maintenance ol ihe imprnvemenl or other ri9hl�obway use herelo <br />applied for and lurther a9recs to remove same upon notice Irom the <br />Cily and to replace public pmperty damagetl Ihereby. <br />Si�nnture o� Applicant Da�c <br />WORK �UTHORIZED BY ThI1S PERMIT �.1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERIdIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />