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ob�e :�-� s <br />Appllcation For <br />PUBLIC WORKS PERMIT <br />Print or Type Qnl>• <br />�ENTG� niu�s /`�O�r��s i2(o SEG-L�"x�/ /11�lc4 u�M/ 6u�tte� <br />Meilinp Address <br />Gity <br />PvGlic Wo�F� PermO • � 7 � <br />ema oec� . s 3 <br />PuDI¢ Worh� iss <br />Tot�l Fea f _ <br />Leo �oG� Fas PUE : _ 9� <br />B�I�nce Dua i 2�/ U <br />7d 3 35� <br />�l %A1g2 <br />Applicant Mailing Address City Zip Phone <br />Geacribe Proposed Work ��ST/�u r�S� �/VE �On/��C'7�� �K�f%--'�%�`� <br />Prolect Address pl known) <br />- �s <br />A��ech lour (4) copies 01 plana lor prOpOsed woik - Draw to scale and nole Ihe lollowinq ns ap0��cable: <br />• Property Lines <br />• Oulline and dimensions ol nll exisling artl <br />proposetl struclures on the lol <br />• Existing and ptoposed utilitias <br />PERMIT CONDITIONS <br />• Cenlerline of strcet <br />• Indica�e North <br />• Show any oroprsed gradiny changes <br />• Show measurfinents <br />t. All calls lor Inspec�ion shall be made 24 hrs. in advance � phone ZSg•A81 5. <br />�. All work ehall be perlormed In accordance wilh Ihis peimit end r.urreM City of Evere�� Oesipn and Construction <br />Standerds end Specificalions. <br />J. CaJ Locetion Underground Sarvico 48 hra belore you dig. TOLL FREE NUMBER 1•EOO•42O•5555. <br />ApprOved lor Cons!r(� ele <br />� 7-�-�-8�_ <br />FINAL INSPECTION Dale <br />Approved as Conslructed <br />everetl PUBLIC WORKS DEPARiMENT <br />� 3?00 Cedar Slreet <br />Everett. WA 98401 <br />Phone:259-BB15 <br />--y4�yz <br />ACKNOWLEDGEMEN7 GF CONDIilONS <br />W <br />H <br />_ / <br />� <br />C� <br />F- <br />� <br />O <br />a <br />The undr�rs9nrA ownoUapplicanl he�eUy agrees to hold and save herm� <br />Icss Ihc City ol [vcrett from any and all claims lor tl�ma�ns, costs, <br />e�penses. or causes of achon ihet may anse because of instnllaUon <br />and mainlenance ol the impiovement or olher nghPol�wey use hereto <br />apphed lor and lurthcr agrees lo remove same upon notice Irom the <br />� y anq lo replace �Ebhc pioperty damaged thereby. <br />� <br />WORl: AUTHORIZED BV THIS PERMIT IvIUST �E STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br />�E DILIGENTLV PURSUcD TO COMPLETION. THIS PERMIT MAY BE <br />CANCf.LLED BV THE CI �Y UP(JN ANV STOPP..,:F OF WORK ON THIS <br />PROJECT OVER 90 DA+S GUNATION. <br />