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, - - <br /> , <br /> Date - -23-t?7 a�m��wo,ksae,mn• ' - �-� !. <br /> �pplicatiun For �mi� ocm •- <br /> PUBLIC WORKS PERMIT Publ¢WOrM9FeB <br /> ,o�a�Fe� s <br /> Less Aoo� Fcc Pa�� S <br /> Print or Type Only ea���«o�� s ��7�'� <br /> Citv o` Everett. Uti7.il�v I�iv+si.on 320n Ce�9ar t;vernt-t 0�2�1 25�-P�1n0 <br /> Owner Mailing Adtlress City Zip Phone <br /> ��-C <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _°lacement of 38,000 C. Y. of material from utility reoair projects <br /> SliPA 14-87 <br /> 3732 Tu � a � i�7 , <br /> -- � <br /> Prolec!.>ddress(ifknown) �'7est of Tulalio and Rr_servoir ;:'4 L <br /> r <br /> Attar.h lour(4)copies ol plans lor proposed work- Draw to scale and nole ihe lollowing as applicable: � <br /> • Property Lines • Centerline ol street ♦^ <br /> • Outlinc and dimensions of all exisling and • Indicale North V� <br /> proposed�.: uclums on ihe lot • Show any proposed c�rading changes <br /> • Existing and proposed utilities • Show measurements Y <br /> Yi 1 <br /> DO NOT WRITE BELOW THIS LINE <br /> P[RMIT CONDITIONS O <br /> L All c;;lls lor inspection shall be made 24 hrs. in aAvance- phone 259-881 S � <br /> 2. All worh shall bc performed in aCCordanCe with�his permit and Current City ol Eveiell Design and Construction <br /> Slnndards and Specifications. <br /> 3. Gall Loaation Under�round Service 48 hrs. be�ore you dig TOLL FREE NUMBER 1-800•424•5555. � <br /> . ,�7-,�. � i �� ��i� i�;����� .-� -� _ , , �S _ . . . . ',�._� , . c -� � ' - � <br /> < - — �.�i�i��C71�c0 <br /> � / — - — . c ` � � -- � <br /> , �LL �7,�: .- _ ._� � . . _ r..'. : <br /> �"� '�,. <br /> � <br /> . . j' � <br /> a <br /> ACKNOWLEDG[A1ENT OF CONDITIONS <br /> Tho urdersigned owner/applicanl hereUy agrees to hcld nnd sme hann- <br /> less Ihe City of Everett irom any and all claims tor damayes. cosis. <br /> _ e>penses, or causes of action thal may arise becausc of installation <br /> - ' � ...-j� �,.�� _ �� and m�iMenance of the improvement or other righl�of�w�y use hereto <br /> � � applied for and Iurlher agrees to removc same upon nolicc Irom the <br /> Approved ior Coostruc ion �' Date City and to replace public property dama9ed thereby. <br /> � 74+� <br /> -�_�,�/���.,�� � � <br /> FINAL WSPECTION Date �/�. /��� � � <br /> APnroved as Conslructed Sic�nature nf Applicant � Date <br /> �y-iy�,❑ PUBLIC WORKS DEPARTMENT �NORK AUTHORIZED BY THIS PERMIT MUSi BE STARTED WIIH!N <br /> � 3200 CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> [verett. WA 98201 BE DILIGENTLY PURSUED TO COMPLETICIN THIS P[RMIT MAY 6E <br /> Phonr. ?59��615 CANCELLED 8Y THE CITV UPON ANY STOF. 3E OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURAT�ION. <br />