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� � <br />H <br />� � <br />H�� <br />K C! <br />� <br />�w�� °� <br />o�d <br />�i a�a <br />�` <br />H <br />�pH�7 <br />OyW <br />�OW <br />� <br />� L� <br />�� <br />1 <br />Date�2L-92 <br />� <br />Application For <br />PJBLIC WORKS PERMlT <br />Print ur T� pf; Only <br />� f'�pl�[ V.lr�t6 �' _ __ <br />���a o��v . Y38079 -----, -- <br />P�,�,�wo,�.•�a s -- <br />TMe1 iee <br />Leae �ppl fee Pam S�_ <br />Heinnw Due S <br />James A Staniford 1508 Hewit[ Everett 98201 252-6639 <br />Owner Mailing Address Gty Lp Phone <br />Owner <br />Mailing Address <br />Desr.ribe Proposed Work . Exit dooi 6 5[aiiway <br />Projetl Address (il known) 9 Z� <br />Zi� Phone <br />Attach lour I4) copies ol pi ins lor pwposed worh - Draw to scale and note t�e lollorvmg as applica6le: <br />• Pronerty L�nes • Centedine ol street <br />• Gutline and dimensions oi all e.isting and • Intlicate North <br />proposed slrutture5 ��n the lol • Show any proposed grnding thanges <br />• EzistinB and proposod utilities • ShOw measwemenls <br />PEFMIT CONDITIONS <br />i. All calls fer inspection shall be made <4 hrs. �n advance • phone 258•0810. <br />2. All work snall be pedormed in accordance with ihis permil and currenl City ot Everet� Design and Construction <br />S�andards end Specillcations. <br />3. Call Locatlon Untlorground Service 48 h¢. 6eloro you diq. TOLL FREE NUMBER 1-800-424•5555. <br />/��6�� ��;�,����-,: f �'u.����.�«.,�,� <br />Approved br Conslruclion Date <br />RN�L INSPEC110N Date <br />dpproved as Construr.ted <br />�% PUBLIC WORKS DEPAFTMENT <br />�3200Cederg�reel <br />Everet'. \YA 98201 <br />Pho io: 259�8810 <br />ACKNOWLEOGEM[NT OF CONDITIONS <br />� <br />Q <br />The untlersiqned owneVapplican� hcreby agrees �o hold and save harm� <br />less Ihe Clly of EvereU hom any and all claims lor Uamages, cos�a <br />CxPCn5C5. Of CaU525 0� BCIIOn Iha� fn3y BnSC UCCauSC O� instaila�ior <br />and main�enance ol ihe impmvement or olher righl�of�way use herelo <br />applied tor and lurther �9ree5 to remove same upon notice Irom 'he <br />City and to replace public property damaged Ihereby. <br />Signature ol Applicant Dalc <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE START[D WITHIN <br />180 DAYS OF DATE PERMITISISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETIOIJ. THIS F'ERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WOPK ON THIS <br />PROJECT OVER QO DAYS DURATION. <br />