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��:u�'� <br />Date � � '- � � <br />ApPlitation i or <br />PUBLIC WORKS PERNEIT <br />PriM or Type Only <br />r � �,-..1 (— <br />j�— Jt / <br />1'..I� : \':.� n.. 1'...i.. LJ ��� ��-yy�/�� <br />[�ien o��ni • ._ ���'�✓-�`-+�—' <br />v�ni��wo��tF�� -------- - --- <br />,a„� FP� 5 -- <br />luss nnN Fce anm S--T--- <br />oaianr.�o�� 5 ?`��� <br />����— �� /� <br />,,..,,i;,,,,� Madm9 Address Cdv Zip Phone <br />- ;�, - _ �,- <br />Pro�ect Address lif knownl — <br />Altach lour I�) cop�es of plans for proPosed work � Draw to scale anA note Ihe �ollowmc� as apU�icable�. <br />• Property Lines <br />• Outline and dimensions ol all ex�sting and <br />piopo5etl SINc�ures On iha IOt <br />• EwsUny and proposeA utilities <br />• CeMerlmP ol strect <br />• Indicale North <br />• Show any proposeA gradinr changes <br />• Show measuremeMs <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall 6e maAe 24 hrs. in advance- Phone 2$9•8810. <br />2. NI work shall be pertormed in accordance with lhis permit and current City ol Everett Design and Conslruclion <br />5tandards and Specifications. <br />3. Call Location Und��rground Service 4'� hrs. before you dip. TOLL FREE NUMBER 1•800•42O•5555. <br />1�`��`'� ,���� - <br />, <br />N.,�;r �'� /c/='�' � <br />Approved lor Construcf Date <br />� ��� � /-/�� - yo <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Slreet <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGGMENT OF CGNDITIUNS <br />Thr. cndersigned ownedapplicant hereby agrees to hold �e harnr <br />less the Ciry ol Everett Irom any and all claims for c ,zs. costs. <br />expenses. or causes of ar,�lon that may arise becaus. '�naLJlation <br />and mainlc•nance of the improvemenl or olher ri�ht�ol-way usr hereto <br />ypplied lor and luriher agrees to remove same upon notice ��:om the <br />City and to repl�ce public properly d:. maged thereby. <br />`f � <br />/Lo-�N,�a.,_, � �—C `c� <br />SignaWre ol Applicant Date <br />IVOR:t AUTHORIZED BY THIS PERMIT MUST BE ST; RTED WITHIN <br />180 DAYS OF DATE PERtv11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 8Y 1 F1E CIT1' UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUR�TI01J. <br />