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� - -- .. . — -- <br />Date`-' ��r' I <br />� <br />Application For <br />PUBLIt; WORK� PERMIT <br />Print or Type Only <br />I <br />; �=�►11�1"�XS �_ <br />I oW�e� <br />i ��� <br />�� Applicant <br />� �i� � � 1�"� � <br />Mailing Address <br />itv <br />j�'i <br />PuO��c Worha Parmit • `�� <br />Bidp Depl • �� � ""� <br />1`ubbcNodeFeo s <br />lol; I Fce <br />lnsa App Fca PnE s_�f/�(J <br />�emnce Oue S �=Y��' <br />Nnone <br />Dascribe Proposed Work � �"� � �� �� �-1 � �`�� 1 �r2 e,�x�. 1 T�1GCll� <br />P�o�eclAddress�i�knovm) /y2� — �?G -�� <br />Attach low (A) copies ol pinns fOr p�oposed work • Draw lo scale end note the loll�wmg as applicable: <br />, • Property Lines • Centerline of streel <br />• OuUlno and himensions of all existin9 end • Indicate Norlh <br />� proposed slructures on Ihe lot • Show any ptoFosed grading changes <br />- • Existlng end proposed utllities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor Inspecllon shall be made 24 hrs. in edvance � phone 259•887 5. <br />2. All work shell be parlormed in accordance with �his permA and currenl City ol Everett Design and Cons�ruchon <br />Standwrds nnd Specificetlons. <br />3. Call Locatlon Underground Service 48 hrs. br,lore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i9,uy ExrE,�,e�� ��e o,v �o�- :�-;,,_� ,c��-��.,,_ ,� <br />f UR[ i� ! i�Oi'�"-f DEf�F' �'Ti.vl�c/T �''.�'.��i �Dl/fI L, <br />��Bioah�-- 6' 6 b' � <br />ApprovedlorConsductlon Dale <br />FINAL INSI�ECTION �a�e <br />Approved as Constructed <br />,.������ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreel <br />Everett, WA 98201 <br />Phone: 259�U815 <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMFNT OF CONDITIONS <br />Thc undersignetl oviner/applicant hewby aprees to hold end save harm� <br />less the Ci�y ol Evnroll Irom any and all claims for damagas, cosls <br />exponses, or causos ol nclion Ihot may arise because of installa�ion <br />and mainlen�ncc ul Ihe improvemen� or other �ighl�obway use hereto <br />applied lor and funher agrees to remove seme upon nolice liom Ihe <br />Ci�y xnd to rBplace public property damaged ihereby. <br />i <br />c.� � <br />, �.. <�� i �� ���c-r.�� ��3d�� <br />� Sig7�fu e ol Applicent � Da�e <br />W6RK AUTHORIZED I3Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLLTION. THIS PERMIT MAY BE <br />CANCELLED BV THE CIiV UPON ANY STQPPAGE OF WOHK ON TNIS <br />PROJECT OVER 90 DAYS DURATION. <br />