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z <br />Date �-� .—�� <br />Applitation Foi <br />PUBLIC WORKS PERMIT <br />Print or iype Oniy <br />Applicanl <br />Descnbc Pr000sedlVork <br />Prolect Address �ii knownl <br />Adtlress <br />2ip <br />Attach lour IA) copies ol plans lor proposr.d work - Dr�w Iu scale and note the following as apulicable: <br />• Property Lines <br />• Outhne and dimensions of all existing , ntl <br />prOposetl s�ruCtures on Ihe lol <br />• Exishng and propoSeA u�ildies <br />�� <br />y��j � <br />r��oi,�.wo�.arr•rm� `� 1 ��. <br />uin� ocoi • _��_ . ��� <br />1 <br />vunnr.Wm�sGee __--_._—___. <br />toinl l'ec 5 _ <br />lessAppl Gnp Pa¢I $ <br />PalinceDue S ���� <br />• Cenlerline ol street <br />• Indicate Norih <br />• Show any proposed gratling chnn�jes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in ativ,�nce - phonc 259•8810. <br />2. All work shall be pencrmed in accordance with this nermit antl curreN City ol Everett Design and Conslruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-$00•Q24•5555. <br />fi �Z li �_ �' 1` kv.c� <br />; � -����'�j <br />Approved lor Construction , Dalc <br />.�G� ��CiC% �- 02 fJ <br />FINAL INSPECTION Data <br />Approved as Conslructed <br />everen PUBLIC WORKS DEPARTMEP:T <br />� 3200 Cedar 8!;eet <br />Everett. WA 98201 <br />Phone: 259�8010 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />,� <br />W <br />� <br />� <br />� <br />■ <br />� <br />O <br />a <br />The undersigned owner/ap �licant hereby ag�ees to hold nnd save harm- <br />less the City ol Everett Irom any and all claim, lor tlamages, costs, <br />eapenses, or wuses ol aetion that may arise because ol instqllation <br />and mamlenance of the impiovemenl or other righl-ol�way use herelo <br />apPlied lor r 1 lurther ;�yrees to remove same upon notice irom the <br />Cdy �nd to �eplace pubhc property damaged Ihereby. <br />_l�� � ° / L 3 /�' �' <br />i <br />Sicj ature ol ApPli� Dale <br />WORK AUTHORIZED DY THIS PERMIT MUST k3E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANC.=LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />