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Pu�hcWorkePermlt �� — ��� <br /> Date <-'' � ,� Y <br /> ! siae.oeo� + <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT ''veTotnlimFae s <br /> LessA00��FeePeid S �� <br /> Balenn•Uue S <br /> Print or Type Only <br /> � nQ. ,__ r.. �, �OF -/�'-hS7 /7�U.Fi�TEC �8275 �,� 3 —2 i�G' � <br /> Owner MaJing Address Cily Zip Phane <br /> ��� M1���f Madmg Address Ciry Lp Phone <br /> App icant <br /> Describe Propo�ed Wark � � ���� ` �� � � ��� " �� / r� /� <br /> i/,_�1�,�L'� — <br /> W <br /> // , � <br /> Pro�ect Address(if known� ' T ��� � �y���SO�✓ � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine ol s�reet � <br /> • Outline and dimensions ol all existin9 and • Indicale Nor�h <br /> proposed structures on the!ot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements M <br /> W <br /> CO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls 1or inspection shell he made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be performed in accordance v.Ah ihis permit and curreM City ol Everetl Design and Construction <br /> Stendards and Specitications. <br /> �'i � t. Call Location Underground Service 48 hrs. belore you oig.TOLL FREE NUMBER 1-800•42�{•5555. � <br /> 01/02/87 10�45AM OOORIt351 <br /> / Oq00017341 <br /> 6LDG 5446.00 � <br /> e�� sso.cm <br /> NECH t28•50 � <br /> PLN CH S^c0.47 <br /> , B Sf'iCH s1.50 O <br /> E SRCH 515.00 <br /> � s?Q.� a <br /> aooa�s9ss <br /> SF.WER i30.00 <br /> FkID II `72Q.00 <br /> 1171-5 4650.00 <br /> ACKNOWLED(�Z�O COiC�ITIONS <br /> -�/�� The undersigned owner/applic�T�raby��hold and save harm- <br /> ��Y1R "- less tte Ci�y of Everett Irom��nd �k7for damages, custs, <br /> expenses, or causes ot action that may er,se hecause of installation <br /> �� S and mainl ance 9� ihe improvemr oc or other right-o4way use hereto <br /> .i� �� �d�`�B� applizd r nd ur her a es to remove same pon notice hom ihe <br /> � ApProved br Cohstr on �a�e Ciq�a t re ac publ' property da e tl� by. <br /> p / <br /> �R%�i '�_�/ � -- _' <br /> FINAL INSPECTION Uate Date <br /> Approved as Cunstructed Sig ture ol Ap caQt <br /> WORK AUTHOR17.ED BY THIS PERM MUST BF STARTED WITHIN <br /> ererett PUBLIC WORKS DEPARTMENT 180 DAYS OF D.4TE PERMIT IS ISS D AND THEREAFTER IS TU <br /> � 3200 Gedar Sireet BE DILIGENTLI' PUPSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> ?hone�259�8815 pROJECT QVER 90 D,4YS DURATION. <br />