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Date 2/17/88 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Us <br />11824 N. Creek Parkway <br />Mailing <br />Public Worse Permil• <br />Bldg. Dept a <br />Public Worse Fee $ <br />Total Fee <br />Leas April. Fee Paid $ <br />Balance Due $ �/� <br />Phone <br />Associated P & C <br />Engineers Inc P. 0. Box 20097 Billings MT 59104 406-252-4113 <br />Applicant Mailmg Address City Zip Phone <br />Describe Proposed Work Construction of US S arint buried facilities in <br />the Lowell Area of the City of Everett <br />Project Address (If known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />S� IVq,,AI7-,9,xl .<i iylinliinG'A? �� /%�'�ZOa/T9Lc�/ i—OM <br />Ep�E Ti_'�i✓Gs! To VA/ <br />s, Zna .9va�, <br />6-- eeo c'c To aF 'e-.)' /w. f�.� Q iP/�fbrOl�i"i� Ae'!rwS <br />vsr-JF-0 .2-aI, -s8. <br />C; 2 98 <br />Approved for ConstructrbI ate <br />FI SPECTION Date <br />Approved as Constructed <br />evemtt PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everele tt, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />z <br />0 <br />Cl) <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and t.11 claims for damages. costs, <br />expenses, or causes of action that me) arise because cf installation <br />and maintenance of the improvement 01 other right-of-way use hereto <br />applied for and further agrees to remote same upon notice from the <br />City and to replace public property damaged thereby. <br />&eM2t1Q- at!/.s 50l 2-17-M <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THI; PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERP,� T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSI;cD TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TP� CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEn 90 DAYS DURATION. <br />