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X) <br />C H <br />YHN <br />K O <br />H �1 <br />H <br />x <br />q t7 <br />OH�y <br />�MO <br />0 0 <br />H <br />xy <br />�HH <br />t7 N <br />O H <br />O t7 r/1 <br />��hr7 <br />zH0Eo <br />um <br />�, <br />ft aw <br />Date4A <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Wm•• 91"; Permit. T7 Q� <br />map poor • <br />he�K won. ree i --- <br />touliee <br />r e.•Apo. I'.. e. a <br />a.,.... 0.. f <br />_ S Meibng Address Clty LP Phone <br />Applicant �T �/ <br />Describe Proposed Work /YAdd A r't yD Si igk Arklrv - <br />Project Address tit known, <br />Attach lour (41 copies of plans for proposed work - <br />Draw to scale and note the following as applicable'. <br />• Property Lines • Centerline of street <br />dimensions c4 all existing and • Indicate North <br />• Outline and <br />proposed structures on the Icl <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance • phone 259.8810. <br />2. All -vork shall be performed in accordance with this permit and current City of Everett Desulri and Conmr.iction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />lC - 'k-'ekI`I <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />Ever tt.WACedaStreet <br />Everett, WA 98201 <br />Phone: 269.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />end maintenance or the improvement or other rightol-way use hereto <br />applied tot and further agrees to remove same upon notice from the <br />City and to replace Public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 />