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Dat�-�._.o. .?�,�,�.�.-� i�,�ni��w„�.n...,��i. ----- - � <br /> . APPLcahon Fin Bm� D.p� . —._— -_. . <br /> PUBLIC WORKS PERMIT ���°,�°w°��,°°� - _ <br /> loln�rer S-. <br /> Lvss Pno��er Pa�n 5 <br /> 2nlanr,n pnn S ��'�« <br /> Print or Type Only -- <br /> ��5's-yo9s <br /> Q�TTV l3. lYt (( �- t� Zi V � e � C �e �� �= ✓( Wr4, % �L °-3 <br /> C)wne� —A�ih�g Atltlress City ' 7ip� Phone <br /> Applicant Mading AAdress Cdy ZiP Phone <br /> Destrihe Pio{:oSCA\Vork �'✓t-c�=- O? �''�i"�"n+-� `.�-S�"l"uQ'f- -�J '�l �"a-�= �'�iu V <br /> Cl <br /> W <br /> Prolect Atldress lif knownl ��+�'S— V��'�-� G.P�X __ _ � <br /> �itach low 1�71 copies ol plans 1or p�oposr.d w0�k� Draw lo scale and note 1he fnllowing as aPpiicable�. � <br /> • Propeny lmes • Centerline ol street � <br /> • Out��ne and dimension,of all ex�shng anA • Indirate Norih <br /> pionosetl structwes on Ihe�M • Show any proposed gradinG chanyes <br /> • Eaislmg anA U�oposed ul�hlirs • Show measurement5 � <br /> DO NOT WRIT[ BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AJ calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.A:I work shall be peAormed in accorAance with this pevmit and current City ol Everett Design and ConsVuction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE t�UM8E5 1-800•42A-5555. � <br /> f`�F.�' �i�1'�JC/f£� S.f'.rTCy. O <br /> }lc,�c3Gic c�o,e,rS f�.�,�rn�r �vUr .�'.Eq�r�.�v � <br /> d�� '/� <br /> l.� �6�6'� v♦ <br /> � <br /> a <br /> ACK1dOWLEDGEMENT OF CONDITIONS <br /> The ucdeisigned ownedapplicant heieUy agrees to hold and save harm� <br /> — Iess Ihe City ol Everett irom any and all claims for damac�es. costs. <br /> ezpenses. or causes of action ihat may ari,,: because of inslallation <br /> and mamtenance ol 1he improvement or olher rigM�obway use hereto <br /> appGed lor and Wrihcr a9mes to remove same upon notice Irom the <br /> App-oved lor Conslruction Date City and to replace pubhc property damaged Iheieby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUiHORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLICWORKSDEFAR'MEN"i 180 DAYS UF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3"<OOGedarSireet BE DIUGENTLY PURSU[U TC COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA90201 C�NC[LLED BV THG CITY UPON�NY STOPPAGE OF WORK UN THIS <br /> Pho�e:259�8810 PROJEGT OVf_R 90 DAVS DUR�TION. <br />