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Date���� <br />ApPlicaiion For <br />PUBLIC WORKS PERMIT <br />Print or Type Unly <br />�„�,,�,•,�,..�..,m�;..y_ B9� `�68 <br />uina o�oi . _�� 4/�1--�—/— . <br />Puei�cwor�sfce S— � <br />�OIRI iPC <br />L¢55 A(�OI FPP Pdi� � � <br />Od <br />BalancrDue $_�Q�-- <br />AppliwM <br />Descnbe Proposed Work <br />MaJ�ng Address <br />Zin Phone <br />P�o�ect Address �d known� ������ �� � %� — l i'% i /7"i(l/' ,L /�l ,� <br />�^T�--- — <br />Attach fow (4) cop�es ol plans lor proposed wo�k � Drav to scale and note the followmg as apUlicable� <br />• Properry Lines <br />• Outline and dimen5ions ol all cristing and <br />prOpoSed SlfuGtufP.s on �hP lo� <br />• Existing and proposed utihlies <br />• Genterlme of street <br />• Indicatc North <br />• Show any proposed gradmg changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone ZS9•68i�. <br />2. All work shall be peAormrd in accordance with this permit and current City oi Everett Design and Cons�ruction <br />Standards and Specifications. <br />3. Call location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•420•5555. <br />�i,� cS'-� G.io�.� ��.1` �C c,�.r� �-Piv �i�,.. <br />�evaa0 e-.,� /e7-� S9 �.�-" J`�c��<-,�/c�lc�� lZC , <br />�' �ja.y ��4-c�G-a� . <br />• ' / <br />S C�-,�f ,to ,�2�0 ��e-riccQei u.�j ��e?�Ti�+.n.,+cy <br />/ � �J � �uJ .ic.o�-WrtX./L ./1.F�O�a��'"a^ � <br />9va�a <br />.�/E7ocr� ��'S �% _ <br />Approved for Construction �'-�t <br />_����,c-�� 5-��-s�, <br />FINAL INSPEC�ION Date <br />Approved as Construcled <br />everett PUBUC WORKS DEPARTM'cNT <br />� 3200 Cedar Street <br />Everell. WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGflMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undrrs�gned owner/applicant herebyagrees to hold and save haiin- <br />less tlie City of Everett irom any and all claims inr damages, cosis. <br />e-penses, or causes ol ac�ion Ihat may arise because ol installation <br />and maintenance ol the lmprovement or other right-obway use hereto <br />applled for and furiher agrees to remove same upon notice Irom Ihe <br />City and to replace public property damaged ihereby. <br />%c,�,_��.� / ,' "� <br />SignaW�e ol Appli. �nt ate <br />WORK AUTHORIZED Y TIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED 10 COMPLETION. THIS PERMIT MAV BE <br />CANC[LLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />