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i �-• 1 , <br />Date ���,., � ���'�"��� <br />Application For '� �'����1� <br />PUBLIC WORKS PERMIT <br />Prinl ar Type Only <br />Owner <br />�- <br />ny Atltlfe85 <br />c�iy <br />Describe Proposed Work V� - ��'��i T�1_SLJ11� -- --. --. <br />Pro�ect Add�esa lil <br />aG / <br />f'ul�l.r Wn�46 1'i.r �'v,� . �c._. ._ <br />/ <br />ei,ni ro.�n • �— � .. __ <br />f�ililii �y���151�'n <br />tnlallrn S _ <br />1•�ss Appi fee FmU S <br />B.�bn. n Pun S ��� <br />Phone <br />-- ��' a� 5'� <br />Zq, PhonP <br />Attach low (4) coples ol plans lor proposed work � Draw In sr.aln anA note the follu.ving as appi�cahle. <br />��� • property �ines • Cenlerline ol shr�et <br />• Ou�line entl dimensions of all eMishny and • InAicnle Norlh <br />� proposed Struclures on Iha IDt ! Show any proposed yrading rhanycs <br />� • Existing and proposed utiGtias • Show m�asuremenis <br />PERMIT CONDITIONS <br />1. All cnlls for Ins, ection shall be made 24 hre. in advence � phone+ 259•8815 <br />2. All work shall be perlormed m accordance with this permd and current City ol Everett Desiyn enA Conslruclion <br />Standerds end Specilicelions <br />3. Cell Locetion Undeiground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•�.24•5555. <br />�� / <br />,`/, ,,.r;�, c,��_,��:�.����/ �S' �ri'��r�� i. ��•-r3:�� <br />_� 4//� <br />�oved I o ructi n � - � D te <br />. G� �� � � �� 7 � <br />�, <br />FIN � I C ON � Date <br />Approved as Conslrucletl <br />����.��.�� PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedpr Slreet <br />Everett. WA °`.!201 <br />Phone'.259•P�'15 <br />� — <br />W <br />� <br />� <br />� <br />� <br />♦r^ <br />V+ <br />� <br />a <br />ACI:NOWLLDGEM[Nl OF COiJDITIONS <br />The undorsignod owner/applicnnt hereby ap�ees to hold and save harm� <br />less the Cily ol Eve.rell Irom nny nntl ell cloims lor damAges. cosls, <br />eapenses, or causes ol action Ihai may arise becnuse o� installation <br />nnA mainlOnAnce ol the improvr.ment Or olher riyht-ot�way use here!o <br />applie� for nnA lurther egreos to remove same upon nolice from the <br />City nc (o replace public properry tlamagetl thereby. <br />Signature of Apphcant uam <br />WORK AUTHORIZED B NIS PERMIT MUST B[ STARTE� WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THERFAFTER IS TO <br />BE DIIIGENTLV PURSU[0 TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. --- <br />