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Datel !� 1 N-k� <br />ApUiicahon Fcr <br />PUBLIC WQRh;S PERMIT <br />Print or Type Only <br />.1�n1� <br />A,>pFcan� Mailing AddresS Ciiy <br />r.,����c v.o•�s r.�.��n . _���j__%' __ <br />�;��y o��� • ___�'2� z33S8' _ _ <br />Pub4[ WorAs Poc <br />fmal Fee 5 _ <br />Le55AppIFnpPaNpJ ____ <br />�aiam..Dun $ ZC' _ <br />Fhone <br />✓. <br />Descnbc Proposed Work �P(A1 L!u �1��/-� _ _ <br />T <br />Projecl Address (il known) <br />Attach four (a) coples of plans br proposed worA � Dra�v to scale and note the lollowing as apUlica6le: <br />• PropertY Lines <br />• Outfine and dimensions ol all existing and <br />proposed siructures on the lol <br />• Existiny and proposed utilitie5 <br />• Centerline ot stree� <br />• Indlca'e North <br />• Show uny proposed gratling cha �ges <br />• Shoa measuremenls <br />PERMIT CONDITIONS <br />1. AII calls tor inspection shall �e made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with �his permit and currenl Ciry ol Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. hefore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />_ r� –�1�, <br />Date <br />,. - <br />/ � G' <br />� �/l !l��— " c.� ��'JC <br />FINAI. INSPECTION Delc <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTM1IENT <br />� 3200 Cetlar Sireet <br />Everett, WA 98201 <br />Phone�,259�8810 <br />ACKNOWLEUGEMENT OF CONDITIONS <br />W <br />H <br />N <br />� <br />O <br />The unAersi[�ned owner/apP�icant htreby agrees to hold and save harm� <br />less Ihe Cdy of Everett from any and all cla;ms for damages, costs, <br />expenses. or causes of action Ihat may arise because ol installation <br />and mainlenance ol the improvement or other nghbol-way use hereto <br />applied for and lurther a�recs lo remove same upon notice Irom ihe <br />Ciry a��d to replace �ubli properry damaged thereby. <br />���-� /-3u-5u <br />Signalwe ol Applicant Date <br />WOHK AUTfiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 UAYS OF DATE PERI.IIT IS ISSUED AND THEREAFTER IS TO <br />BE GILIGENTLY PURSUE� TO COMPLETION. T:iIS PERMIT MAY BE <br />CANCELLEC BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJ[CT O'J[R 90 DAYS DURATION <br />