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I <br />Dale4lo/kq TO POSTIN <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />'abut wart Permn• • /,� / _ <br />.de D.Pr • — <br />W4 WarEe t .. <br />1MM Fee <br />e.. Abni Fee P.m i <br />I.LRe Due • <br />SOOwnner� Mailing Address ty Zill Phone <br />APPlica Melling Addressss,�t ,tGly ZiP Phone <br />Describe Proposed Work ��t ry/a M,.' L /4—A,� <br />Protect Address lit known) �doe Z6—� <br />Attach four 141 copies of plane for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all exicting and • Indicate t:orth <br />proposed structures on the 101 • Show any proposed grading changed <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. In advance • phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current Cdt or Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hts. before you dig. TOLL FREE NUMBEA 1800.42445555. <br />LC`z� <br />G<'� L( /2 6�zC�•�cun ��cLc.czY _e. �/. <br />/oyac . <br />PUC wm5 rs-s� <br />Approve qr Conalr <br />�2 A . , AE �z <br />6Ali ale <br />F L NSPE ION 41 eta <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />0 <br />CIO <br />0 <br />Clair <br />The undersigned owner/applicant herbby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. cost& <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 and to replacer public properly damaged thereby. <br />cti1.140-7 <br />natue�rat� 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 110 DAYS DURATION. <br />