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TYPE OR PRINT ONLY <br />F« <br />PUBLIC W KS PERMIT <br />�a� � �,� <br />a2oo cwar sa..t <br />Ev�Mt, WA 9EZ07 25Y•E010 <br />Pl�n Ch�ck Nos B 58196 SaPA <br />Applicat.Dat�s 042/1] 9B <br />p�� -Job 1W��t� MITCNELL�NL/R08LW1AY <br />T�nant� <br />Propo��d ll��t 6�A110I <br />��� D��c. of Mork: <br />N6M DETACHRD 6111U106 <br />D05cribe ProposCd WOAC. ORlICB S8T JOB S&T <br />]1PPROV6D FOR P&RtiITt CTT.rs_/_/_ BY <br />PRO;IECT ADDFESS (if kr own) <br />&iWhq WnN11 <br />Public Works Faa <br />PAor» <br />PAone <br />Anach four (4) copNs of plans fa propo�W vrork - Onw to scab mC not� Ihe fdbwinp H�ppNcabb: <br />'Prop�rty Lines 'Outline uW tlimensions of all exlsNrq �rM propoaed structum on the bt •ExlatMq and proposad uNlkles <br />•Centerline oi street `Indkate Nonh 'Show eny propose0 qrW hq ehr+ga 'Slaw msesuraments <br />PERMI T CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be perfomed in accordance wkh this pertnit and current Cky of EvErett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service �8 hrs. before you dig. TOLL FREE NUMBER t-800-424-5555. <br />•U�LIC 1e�C�n!'c �rRMI-� <br />. .. . . . PiOT �i � �...���.. • <br />,�__ �d---r, <br />RATF----,--'.l� L�'�"l�- <br />Approvetl lor Construclion Date <br />FINAI INSPECTION Date <br />Approved as Constmcled <br />� <br />� <br />♦r/� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONOfT10NS <br />The undersigned ownx/appliwnl hareby agfeu to hdd and tave harmless <br />the Ciy ol Everett from any and WI claims tor damages, costs, expansas, or <br />causes ol actlon fhat rt�^y arise becauu of I�shWatbn and maintenanu of <br />the impravemmt or olher rightroFway usa heiato applied lor and tuther agrees <br />to rertwve same upon notke 1rom the CMy end to replace publi., property <br />damaged thereby. <br />Signature of ApplicaM Date <br />�'JORK AUTHORIZED BY'fHIS PERIdIT MUST BE STARTED WI7HIN 190 DAYS OF DATE PERMR I5ISSUED AND 1HERF�IFTER IS 70 BE DRIGENTLY Pl:RSUED TO <br />COMPLE170N. THIS PFRMIT MAY BE CANCELLED BY iHE CIN UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS Dt1RATION. <br />