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r _�� e <br />Date <br />Anoliration For <br />PUBLIC WORKS PERMIT <br />x C �1 <br />CfaH <br />C !� <br />H Y� <br />4 C) <br />H �1 <br />OSO <br />C rA <br />y H <br />IS <br />O Fr <br />on <br />n• � <br />THz <br />r by <br />H <br />gdrA <br />Cr�1 <br />2 r; rn <br />lM <br />1, <br />( <br />Print or Type Only <br />k n <br />Applicant <br />Address <br />City up <br />PublK Won. PermX <br />,."a, <br />. <br />Pubic Werx. Fee S <br />1 W.1 Fee <br />Less APPI Fee Pad S <br />BNanv D.. S_ <br />_ <br />Protect Address it known) —� <br />Attach lour (4) copies of plans for proposed work - Draw 10 scale and note The following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <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 City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1-800.424.5555. <br />No lt, Ft�)111 ( <br />( "Z - q - e7q <br />Approved for Construction Dale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evOrMl PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8810 <br />z <br />O <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <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 />and maintenance of the improvement or other right-obway use hereto <br />applied for and lurther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED A14D 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 />