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HnH <br />xr� <br />�� <br />A�x <br />C H <br />9Hti <br />r <br />H�H <br />�H� <br />�(~AH <br />H <br />z <br />Oyb�y <br />H C�+70 <br />�V nC <br />9 H [�7 <br />t" z <br />HH <br />� <br />C)C[n <br />��� <br />HOfyi� <br />Date��i > . <br />Appliwtion For <br />PUBLIC WOF�KS PERMIT <br />Print or Type Only <br />r,.;,��: wo,r.s rr,m�n _ ( �e� �/ <br />man oop� • <br />Pub4C \VO�FS Fee 5 <br />ra,a� ��� <br />�rssnoN rc � va�e 5 <br />a.,�.,������ s �I O � _ <br />�,. <br />,�%ndv �uan,c� �OGaG ���� nr S�• k✓�raTq8.2v� <br />O� er Mailing Address City Zip Phone <br />Ot i-n <br />Applicant Mailing Adtlress Gty Z� - Phone <br />DescnUe PropoSed Work <br />Prolect Address lif knownl <br />Attach lour (4) copies ot plans lor proposed work � Oraw to scale and note the lollowin9 as applicable: <br />• Property Lines • CeNerline oi s�reet <br />• Outline and tllmensions of all eais�in9 and • Indicate Norih <br />proposed 5lrucium5 on Ihe lot • Show any p�oposed qradin9 changes <br />• Exislin9 and pwpoSeA utiliUes • Show measuremenls <br />PERMIT CONDITIONS <br />1. All colls for inspection shall be matle 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permil and currenl Ciry of Everett Uesipi 3nd Construction <br />Standards and Specilicalions. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Li. C�oSioN Con��lZo� AS D�iuz��v t�Y i��3��C �vnft�S <br />�3S i t�lS ��z.'TCIB, <br />� Y� <br />_���..�YI�Y� �`��-9� <br />Approved for Construction/ `���e <br />� <br />_J`��,.�- . �" .-P'—// �G/ <br />FINAL INSPECTION Date <br />Apprwetl as Consiructed <br />evrrelt PUBLICWORKSDEPARTMENT <br />� 3200CeaarStreet <br />Everett, WA 96:01 <br />Phone: 259�8810 <br />�3/1�/91 <br />/ <br />UFT.: 0 <br />CH[CY, <br />337•.69,�� <br />11:4�RH OOOAN5007. <br />540.00 <br />340.00 <br />ACKNOWLEDGEGt[NT OF CONDITIONS <br />Z <br />O <br />� <br />V O <br />O <br />a <br />Th� undersipned Owner/apP������� hereby a9ree5 to hald, nd Save harnr <br />less the Cily of Everett Irom any and all claims lor dama9es, costs. <br />expenses, or causes ol action that may arise �ecause of installation <br />and maintenance of Ihc improvement or other ri�h1-obway use hereto <br />applied lor and lurther agrces to remove same upon noticc Irom the <br />Ciiy and 1� repince public properry dama ed therehy. <br />�; �� t,�.ctirt�-��� j• � <br />Sic na�ure of f�cai 1 �] ry��� <br />WORK AUTH R - BY iHIS PERMIT M11UST BE S ARTE[3 W�THIN <br />180 DAYS OF�O E PEFMIT IS ISSUED AND TNEREAFTER IS 70 <br />BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT ktAY P[ <br />CANCELL[D �Y THE CIT1' UPON ANY STOPPAGG OP WORK ON THIS <br />PROJEC7 OVER 90 DAYS DUR�TION- <br />