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� � � <br />�Hxt~ii <br />yxH <br />�e o <br />.'11 <br />� VJ H <br />�O�OH <br />�^�g <br />Y. r � <br />ry�N <br />�A <br />C'� � �A <br />�O� <br />� <br />1 <br />! �� <br />Date�---�'� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� ' - ` r 7uf;,`,� e <br />, ; �� � <br />Atltlress <br />cuoi�c Wo�hs Permn • � 30 � / <br />eiog. oea�.• <br />PuebcworhaFca $ <br />lotaiFoe <br />Less Roo� Foe PeiJ 5 s� <br />oamnco ouc � �� <br />0�2-3zZvo�ys3/ <br />Phonc <br />L <br />Proiect Address (il known) <br />nu,��, �nur �4i cooies ol alans lor proposed wo�k - Draw to scale and note Ihe lollowing as applicable: <br />• Property Lines <br />• Outline �nd dimensions ol all existing and <br />propused struclures on Ihe lol <br />• Exisling and proposeC utilities <br />• Centedine ol street <br />• Indicate North <br />• Shmv any proposed grading cnanges <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs. in advance - phone 259-88i 0. <br />2. All work shall 6e pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 40 hrs. betore you dig. TOLL FREE NUMBER 7•800•424•5555. <br />,,`.��,�%n 7/8�93 <br />Approved lor Cons! 1 n Date <br />i <br />�-Ilf'f—f��� �'/� -C! 3 <br />FINAL INSPECTION Date <br />Approved as Constructed <br />��r��� P:IBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />�w <br />_ / <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersi9ned owner/applican� hereUy a9rees to hold and save hann� <br />Iess the Gry ot Everett irom any und all claims lor damages. co=_ts. <br />expenses. or causes ot aclion that may arise because ol installation <br />and maintenance of Ihe improvement or other right�of�way use hereto <br />applied for and lurther agrees to remove same upon notice irom the <br />Cily and to replace public property damaged Oiereby. <br />��u �_ y- s3 <br />g urc ol Ap licant Date <br />WO K AUTfiORIZED BY THIS PERMIT MUST BE STAfiTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M�V BE <br />C�NCELLED Bl' THE CITY UPON AN\' STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 9J DAYS DURAiION. <br />