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qo� <br />,o C H <br />H � � <br />O p: O <br />H 0 It <br />z <br />OOC <br />0• 0 <br />H <br />zy <br />�HH <br />H <br />zq En <br />r-3 0 (A <br />CI <br />Date�f—oR <br />Appht.nlmn Fni <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P�I,M works Pln_LLE— 6P6-- <br />amv Dept • - <br />Puaec Worle F. s <br />TeW Fix.Lase PM iee Fe.O S <br />Balence Due <br />5/k1'Yle 11_ <br />Applicant Melling Address CityZip Phone <br />4 `� �L� 1 BLCILL- <br />Describe Proposed Work _LJ0i <br />W <br />Project Address (1l known) <br />Attach four 14) copies of plans for proposed work • Draw to scale and note the loll,,,nq ,u, ..ppbr.,d Je <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />v <br />proposed structures on the lot • Show any proposed gtading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All cells for Inspection shall be made 24 hrs. In advance • phone 259.8810, <br />01 <br />2. All work shall be performed In accordance with this permit and current City of Evorelt Design and Construction <br />Standards and Specifications. <br />NUMBER 1.800-424.5555. <br />3. Cell Location Underground Service 48 hint. before you dig. TOLLFREEz <br />GO <br />�REE <br />ys9'. / L�/r V 1 �fi+ <br />/v�� �— <br />Fm <br />a, <br />rove for tr w Iton Dale <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />nrrrr❑ PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone. 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm <br />less the City of Evere" from any and all claims for damages, coats, <br />expenses. or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right•ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City an to replace ublic property damaged thereby. <br />ISTV8fiTARTED <br />K ? <br />gn ureofApplhand ps •L,7tDate <br />WO K AUTIIORIZED BV THIS PETiMIT WITHIN <br />180 DAYS OF DATE. PERMIT IS ISSUEf AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />