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Oate u y <br />Appllcellon For <br />PUBLIC WORKS PEF;MIT <br />Print cr Type Only <br />�,. S1F' <br />Puer�c WorM� Permit • __ <br />u�� o.ai . f � Jl���b <br />i�„mK wo... r.. <br />Toltl fae � <br />let� �oG� Fe� PUC i <br />B�I�nn poe s <br />v�. r�, fi 98r o y 3'�7- G/ S� <br />�Y ZiP Fhone <br />PA� •l.✓E5T �'0,�-57. /U/`�7 i H��u r%9S �✓R'KPTT �� uY 35�7-UL/�/ <br />Appllr.ent Melling Ad �aes Cil <br />Y 2�P Phane <br />DeacrlbaPropoaetlWcrk //�D �� /3�Y?jj �'ARPoRT <br />Prolect Atldreae �II knownl <br />�G <br />Attach lour (4) coples ol plenn for proposed work � Draw lo scele end note Ihe lollowing as npphcnbie <br />• Preperty Llnae <br />• OuJme end dimensione of all ex;eting end <br />proposed etructures on Ihe bi <br />• E.1sUng end Proposod ulditles <br />PERMIT CONDITIONS <br />0 Centedine ol streel <br />• Intlicete Nor�h <br />• Show eny proposeA graAmc�r.hangrs <br />• Show measurnments <br />All celle for inspaction ahall be mede 24 hre. in advnnce � phone '259•$8i b. <br />All work ahell 6e perlormed m occo�dance wrth ihis peimi� nntl currenl City ol Everett Design a�+ Conslruchon <br />Stenderde end Specllicaliuns. <br />Call Locnlion UndergrounA Seivice 48 hrs. bebre you dig. TOLL FREE NUMBtR 1•000•424•5555. <br />._' � � _ —' � . <br />� A; proved lor Conriruclion Date <br />FlNAL INSPEC717N <br />App�oved es Conshuctxn <br />rverctt PU�LIC YVORKS DEPARTMEN7 <br />� 3200 Ceder Slreet <br />Everell, WA 98201 <br />Phuna:259�8815 <br />Date <br />�� / <br />i � <br />! �/^� <br />ACKNOWLEDGEMENT OF CGNDITIONS <br />The undeisigneA owner/applicanl hereby agrees to hold antl save harm� <br />less Ihe Gdy al Everetl Irom eny and all cleims lor dame0es. costs. <br />expenses, or c��uses ol nclion ihal mny a�iae baceuse ol mslnllation <br />and mainlenence o� Ihe Improvament or olhei nghPobwey use hereto <br />apphed br nnA Iwlher egrees lo remove seme upon nolice from the <br />Clty and Io replace public property damnged Iheraby. <br />Slgnn�lican� �/�p,,,(—� <br />WORR�AU7�IORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENTLV PUFSUED TO COI�lPLEI"ION. THIS PERMIT MAY BE <br />CANCELLE� 8Y THE CITV UPON ANV SIOPPAGE UF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION <br />