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Ann"cR rot <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPES OR PRINT ONLY <br />_6eo F:09 1114MCS 801 1preheird D/ iilc 60 <br />Ownaf Mailing Address City <br />Date -- 10 14 lq(, <br />Public Wake Perm" a "/1 W39' <br />Building Penn" e <br />Public Woiu Fee f <br />Appncant --- -- Mailing Address City Zip Phone <br />Describe Proposed Work r*r-th 1-EvfGS e, <br />PROJECT ADDRE.iS (if known) 4101 RgC4 1 AVG <br />Attach fmit 14) copeii of ,plans la proposed work • Draw to scale and note the folla" of applkabla� <br />"Property Lines "CvOinP and dlrnm bole of all Pyialing and wol»9Pd Oruclut" on tho kA "E.naing and rropos d of ldim <br />6Genimkne 01 9"'M "Indl(afe hl rlh "Show any IYODO-11 grading (.hang" W,>hpw moaeurmrwnt9 <br />PERMIT CONDITIONS: <br />1. All calla to- inspection shall be made 24 hours in advance • phone 259.8810, <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />4401 3. Call Location Underground Service 48 bra, before you dig, TOLL FREE NUMBER 1-e00-424-8lStSb. <br />pis Keey 61by ji} rmis e, . n At A l l f i xlfes . <br />�. A 5 �r (� IGH �ov;ded vV, r��esN. <br />has soi�lr t►►a;A ;n -4��s A��'1 <br />Approved to trued - i <br />AL NSPECTION <br />Approved as Constructed <br />10�)4/9U <br />Dale <br />10/15/96 1126PM 0MR01826% <br />M00096391 <br />one+ 420.W <br />CHECK $20.00 <br />W <br />H <br />ca <br />O <br />z <br />O <br />O <br />IL <br />tttt <br />ACKiNOWLCDOCMENT OF CONDITIONS <br />The lmdersigned ownat/appllr eM herel/y agrees to hold and save hamitrise <br />the C"y of Cverell them any and all chime Io darnall". Oosts, eNyer.ses, ot <br />causes of action That may on%e because of inelollatlom and mslolwMA0e of <br />the Mnp"wrgm ot older rpM-orwey use Iw_ e/o etplMtl fa end lunhat egu;oa <br />in rmtove same upon nabs from Via C"y and to tedeoe Public property <br />damaged thereby, <br />&gn udr re of AtNNlCanl �`��`� Data <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED V4114IN 180 DAYS OF DATE PERMIT 15ISSUED AND TNERL'AR1ER IS TO BE 181.10E417,Y PUIIIII TO <br />COMPLETION, 11418 PERMIT MAY BE CANCCLt.ED DY TNC CITY UPON ANY STOPPAGE OF WORK 014 11419 PROJECT OVER g0 DAYS DURATION, <br />