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Date �LL� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />nt <br />Describa Proposed Work <br />Prolecl Adtlress (il known) <br />�Z_7'�rh <br />Mailing Address <br />Address <br />L — 7�l tn <br />P.onc Wmb Pnrm�n. •.� /�p ����/ __ <br />BNo �eM � ��.1��{y —' <br />Pultl�: Worh�fee <br />Touliep S <br />latf MPI �nr Pe�O S — <br />n.i,���P o,.� S <br />i�nr.�aa_�inrs�r�i��, n <br />Attach low 14) copies ol plans lo� proposed work - Drnw to scele nnd note the lollowing as applicable�. <br />• Property Lines • Centerline o! slreel <br />• Outline and d�mensions ol all exis�ing and • Indicate North <br />proposed slructures on the lol • Show any proposed gradiny changr.s <br />• Ezlsting and proposed ulilities • Show measuremenls <br />PERMIT CONDITIONS <br />1. All cells for Inspectlon shell be mede 24 hrs. in advance � phone 259•88�0, <br />2. All work shell be peAormed In acco�dance with this permit and cunent Cily ol Everett Design and Construction <br />Slandards and Specilications. <br />3. Call Location Underground Serv'.�e 48 hrs. �elore you di�. TOLL FREE NUMBER 1•800•424•5555. <br />�r ' <br />':.�d�,C C���y_�,rs f3.�,7 ti'% �'�—�,-�:;c�� <br />Approved lor Const�ur.lion Dale <br />FINAL INSPECTION <br />Approved as Constructed <br />rvrrrt� PUBUC WOFKS DEPARTMENT <br />� 3200 Ceder SVeet <br />[verelt WA 9P101 <br />Phonn 259��tl10 <br />Date <br />/��//48 <br />,����� <br />ACKNOWLGDGGMENT OF CONDITIONS <br />W <br />� <br />� <br />r <br />� <br />O <br />a <br />Thr undeisiqnetl ownciiapplican� heieby agrees fo hold nnd save harm� <br />I�ss Ihe Gty ol [ve�et� Irom any and all claims lor d�mnges, costs. <br />exponses. or causes ol action thal may anse 6ecause ol instnll�tion <br />end maintenance ol the improvemen! or other nphPol�way use hereto <br />apphrd lor and lurlhCr a9rcPs �o reinnve Same upon nohr.e Irom �he <br />CiIY ���d In rrpinco Pi�Uhr, proP�'�Iy d:ima9ed Ihmeby <br />Signalwe ol Apnhcant Date <br />WORK AUTHORIZED BY THIS PEFtil1T MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE P�RMIT IS ISSUED AND THEREAFTER IS TO <br />�E DILIGENTLV PURSUF� TO COMPLETION THIS PERMIT MAV B[ <br />GM1NC[LL[D �V THf CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[Gi OVER 90 DAVS DURATION <br />