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Date ¢-�3-87 <br />Application For <br />F'UBLIC WORKS PERMIT <br />Prinl Of Type Only <br />v,�o���wo•.sv>,,,�u P 7- /c�� <br />o�a� oeoi • _ _ _ <br />PuOi¢ Wv�� fee <br />To�al Fea s — <br />LexsRpplfeePpids _— <br />... ,. �.. � S _C��� �—� - <br />_7ity of Everett, Utilitv Qiyi�i_Q1L324LS.rdar _�vi:lc�t 9�20 � 9- .800 <br />Owner Ma�hnq Adtl�ess Cqy Zip Phonr� <br />Same <br />Applicanl Mailing Address Gty Z�n Phone <br />DescribeProposedwork _placement of 36,000 C. Y. of material from utility repair projects <br />SEPA 19-67 <br />Project Addiess (il known) <br />Attach tour (4) ,-.opies oi plans for proposed wmk - Draw b scale and nole the lollowing as applicable: <br />• Property Lines • Cenler6ne ol street <br />• Outlirie and di,�ensions ot all ezisting and • Indicate Norih <br />proposed structures on ;he lot • Show any proposed gradmg changes <br />• Existing and proposed utilities • Chow measuremerts <br />PERMIT CONDITIONS <br />1. All calls for insuection shall be made 2a hrs. in advance � Phone 259-881 5. <br />2. A'I work shall be Derlormed in accordance with this permit and wrrent Cily ol Everett Design and Construction <br />Standards and Sp=cilications. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� �%�„�J,—�,.�/ i%r���'G/Ai� �,�'��,�,�,,.�� r�nUi:c'��� /�--� <br />C-i T� <br />.: � . �L� <br /><,i� <br />S �i�Ofi:E'� <br />..��' .�(�-_-;� �-�: r=-/-�z.' �,— <br />�Si�'c�; - �7' T-- - <br />Tiiri r�J' <br />� ��c� <br />�7 �i <br />_�i <br />FINAL INSPECTION <br />Approved as Ccnsirucfed <br />evereu PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Stree� <br />EverML WA 98201 <br />Phone:259-8815 <br />Date <br />z <br />O <br />'iA <br />V♦ <br />O <br />a <br />�CKNOWLEDGEIdENT OF CONDITIOI;S <br />The undersigned owne�/applicant hereby agrees to holi and save harm- <br />less the Gty ot Everett irom any antl all claims lor damaqes. r.osis. <br />expenses, or causes ol action Ihat may arise because of insiniC�t,on <br />and maintenance ol lhe improvement or other rqhi�af�way ��«� ;,��,�to <br />applled lor and lurther agrees to remove same upon n���i�� r� n��.�, m�� <br />City antl to replace public property damaged theren� <br />o.����y� `��Z���7 <br />Signalure ol App icant � D.nc <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIM <br />180 DAYS OF DATE PE(iMIT IS ISSUED AND THEREAFiER IS TO <br />BE DILIGENTLY PURSUEO TO f,OMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CIN UPON ANY STOPPAGE Of lY/1RK ON THIS <br />PROJECT OVER 90 DAYS DURATIO�'. <br />