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_1 <br />Datel/iAly <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />e PL,nd• <br />fee <br />ee, <br />L <br />r <br />3v .3- E _32O <br />Pi.one <br />Mailing Address r•y -- Zip Phonn <br />Applicant <br />Describe Proposed Work _, �r� <br />Protect Address (if known) 89'-K ST SE <br />Attach lour (4) copies of plans for proposed work Draw to scale end note the 1 3Ilowing ns applicable: <br />e Property Lines • bdnterliue a1 a:real <br />Cn <br />e Outline and dimensions of elr existing erd 6 Ind`ce's Norlh0 ih, AV am ort• jej grodirg .hanges <br />proposed structures on the lot 0 Bhna a .rr, , , t nt.., /� <br />e Existing and proposed utilitica W <br />it ••tsarsN 0 <br />JU NOT WRITE BF.LJVJ TH 5 :..K <br />PERMIT CONDITIONS <br />1. All calls for inspection Shall be made 24 his ,n advaroo - phc at 259.8t315. <br />2. All work shall be paulormed In accordance ,+ith this I-ermit erd cumin: Oily of Ever(it Design and Construction <br />.Standards and gpr-Ilications �s�l <br />3. tall Location Undd,ground Service 48 his before )o r dig TOLL 1=R.iE NUMBER 1-800.424.555 z <br />0 <br />IMM <br />♦ <br />♦^ <br />V♦ <br />0 <br />CL <br />Approved for Construction <br />Date <br />�(`��j''pq� <br />FINALFINAL INSPECTION Dal <br />Approved as Construcle <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 08201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The eby a0tees <br />d and save harm, <br />less theCityEverett owner/afrolicant m any arnd all claims for t fordamages, coats, <br />expenses, or causes of action that may wise because of installation <br />and maintenance cf the Improvement or other right•ol'wpY use hereto <br />applied for and fdAhor agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />SC' al <br />SiF,fM1ature of Apalic <br />WORK AUTHORIZ 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 />z <br />O <br />m <br />-1 T <br />co <br />ma <br />c�r <br />s � <br />m <br />c= <br />x <br />Y H <br />< LA <br />p pT <br />T D <br />rI <br />0 <br />on <br />rn <br />c LA <br />3 N <br />m <br />a <br />