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� <br />� <br />� <br />��� <br />A�x <br />9 Hm CA <br />y z r�+ <br />`G C� <br />H �1 <br />o xo <br />'TJ H'i1 <br />C/1 H <br />LTl O [i7 <br />H C7 <br />��� <br />�1] Y �] <br />ay� <br />r z <br />t-i H <br />N <br />H <br />C] � f/� <br />� r <br />z �3 c�n <br />H O [n <br />Date_12�2.7.�91 <br />H-�2-z8-4 <br />TO POSTIi�u_�_�� <br />Application For <br />RUBLIC WORKS PERMIT <br />Print or Type Only <br />PuollcWarbPermlte35� �O�/ <br />aiev� oeo�. • <br />Public Works Feo S <br />Totel Fae <br />Leas ROot Fce Va'�G $ ��- <br />. . eam��o o�0 5 % Ci <br />UtION BAY COrSTRUCTION INC POB 2208 YNNWOOD q80'+6 '"�67-8421 <br />Owner Mailing Address .. Clry ,, , ZiP Phone <br />,..-. ." ..� ,., �.. <br />Applicant <br />Describe Proposed Work <br />Project Address (if <br />Mailing <br />City Zip Phone <br />Altach four (41 copies oi plans lor proposed work • Draw to scale and note the tollowing as applicahle: <br />S Property Lines • Centerline of streel <br />• Ou�line and dimensions of all existing and • Indicate Nor�h <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Existing and pr�posed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work chall be pedormed in accordance with this permit and current City ot Everett Design and Constmction <br />Standards an�i Specificalions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. � <br />�i• ST/�1LE ,�-�.� � rJ ST/`LL. Go t.;sT 2�' c�� t C N C=[-1�Gc- <br />A�G�' �,o N��nvc c_—ir�c�v�t A..�2c�- d��=vr_E srn��r«Y,� <br />�CNST�V�-�l(�I�, <br />:7 � TE�IPCCz��t=-� [ P-�%.�l OIU GON TIZC�L NIA�( f3�. i�� ca; ���L�7 <br />J�S �l 12�TE(i l��( V��% �LI C. \�2K$ 1�%5 PEC.Tt�IZ. <br />Cfl . D I fLE�-T S'TD'R. M P R-A l 1J AC-�,E 'TD D2Y �V� �L <br />�f� I`��1` �e-� I - � - 9�- <br />Approved for Construplfon Date <br />i/ <br />��� f' � - a�<3 <br />FINAL I� ' . Date <br />Approved as Constructed <br />PUfiLIC WORKS DEPARTMENT <br />3200 CeJar Street <br />Everelt, WA 98201 <br />Phone:259-8810 <br />� <br />� <br />� <br />V♦ <br />e <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned �•.��ner/applicant hereby a9rees to hold and save harm- <br />less the City of Everett irom any and all claims lor damages, co,is. <br />expenses. or causes ol aclion that may arise because of installation <br />and maintenance ot the improvement or othei ric�ht�ohway use hereto <br />applied for and lurther agrees to remove same uFon notice from the <br />City and tp-S �ace puolic property da aged thereby. <br />�,� <br />� <br />` � ' <br />ignature ot Pplicant Date <br />WC1RK AUTHORIZED B THIS ERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PER ISSUED AND THEREAFTER IS TO <br />BF. DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCE'_LED BY THE CITY UPON ANY STOPPAGE OF `NORK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />