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r <br />r <br />Date 5 - /b 8 3 <br />Apphcalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />rumic Won. P•.md.� �/� _ <br />e'dp e.Pt <br />T.,.�f.• <br />L.n.Pr•, r•• Pad f i <br />aWnca eu• � '� <br />project Address (11 known) ' applicable: <br />• Centerline of street <br />d work • Draw to scale and note the <br />Attach lour 141 copies of plans for proposefollowing as <br />• Property Linea • Indicate North <br />• Outline and dimensions of all existing and a Show any proposed grading changes <br />proposed structures on the lot 0 Show measurements <br />• Exiuting and proposed utilities <br />_,. .,.,..nrortF RFLOW THIS LINE <br />q6 <br />PERMIT CONDITIONS <br />1. All calls for Inspection shell be ccor en hra in advance • phone 259.881 <br />2. All work shall be performed In accordance with this permit ana current City of Everett Design and Construction <br />Standards and Specifications <br />3. Cali Location Underground Service 48 his, before you dig. TOLL FREE NUMBER 1.800.424-555 <br />lt1G N <br />CXr9}r.•` dr..•dwny n(u <br />bN,�det ,1 j tl •� I .� ro <br />�tsH.,c. <br />�n <br />l,Pt.c1t� fC nk� <br />-I�e enrs�-Iw, �{r•Jewa M,,.t� be nn <br />p(0.ct•� w.3l. Ik pewo� <br />r <br />fC .�1�C � GrA/•t:) � U. Eke e..a oc s �tww �1� ti%a 11 <br />1 � <br />a.(� 0.ctwt�3.3. 7 0� <br />be fee See-�r^� <br />WW, <br />ICppeoveo mw..•._.._.- <br />Lt <br />L Data <br />FINAL INSPECTION <br />Approved as Constructed <br />evcmtt PUBLIC WORKS DEPART ENT <br />© Ever Ceder Street <br />98201 <br />Everett WA 98201 <br />Phune: 259.8815 <br />L. <br />ca <br />O <br />Z <br />O <br />rl <br />N <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/aPPllcant hereby agrees to hold and save harm- <br />less <br />l <br />expenses, or causes of action lh.•t may arise becau ee Of a Installation <br />maintenanceand <br />for and further agrees improvement <br />eto <br />agrees 10emove other <br />same upton noticeefromr <br />appliedthe <br />City and to replace public property damaged thereby. <br />Ignalure of Applicant BE STARTED WITHIN <br />WORK AUTHORIZED BY THIS PERMIT <br />ISO DAYS DATE PERMITISSUEAND THEREAFTER IS TO <br />BE DIILIGENOTLY PURSUED TOICOMPLETION. THIS PERMIT MAY BE <br />CANCELLED 13Y THE CITY <br />PROJECT OVER 90 DAYS DU0N ANY <br />STOPPAGE OF WORK ON THIS <br />Rt <br />'1 <br />J <br />L. <br />J <br />