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Date� i� � <br />Applicalion For <br />PUBLIC V✓C7RKS PERMI�" <br />Print or Type Only <br />Owner <br />Applicant <br />Mailinc� <br />Descnbe Propose4 Work _�A 1-� � 1+ !(/_1V`'�� <br />Project Address (il known) <br />Attach lour (4) copies ol plans lor proposed work - Drav <br />• Property Lines <br />• Ou�6ne and dimensions ol all existing and <br />proposetl slrucWres on ihe lot <br />• Existiny and prcposed utilities <br />scale and note the fi{lllowing as applicable: <br />i'JIiC VJOriS {'�•rr:�il ��}I <br />6in9 Dcot , __/( _ �Si.��_ _—.— . <br />Publm Wo�As Fec � <br />iol.11 FeC $ _ , <br />less Anol. Fee Patl $ — <br />[3alance Our. $ _ <br />• Cenlerline ul street <br />• Indicate North <br />• Show any propcsed �rading chan�es <br />i `,how measuremenis <br />Phonc <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 pedormeC in acwrdance with this permit and current Cily of Eve�ett Design and Construction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. before you dig.?OLL FREE NUMBER 1-800-424•5555. <br />n�,�-�- <br />� v% ���lJ//'Li'.d <br />lor Consiruction <br />FINAL INSF'ECTION <br />Approved as Construc!ed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Evere�t. WA 99201 <br />Phone: 259�8810 <br />7/ <br />Z"' p <br />��/�_7 %-�7 B <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />_ / <br />� <br />� <br />O <br />a <br />The undersigned o�vnedapplicant hereby agrees to hold and save harm- <br />less the Cdy ol Everell Irom any and all claims lor damages. costs, <br />ezpensec, or causes ol action Ihat may arise because of installation <br />and maintenance of Ihe improvement or other right-of�way use hereto <br /><�pplied lor and further agrees to remove some upon notice Irom Ihe <br />Dote City and Io replace public property dama�ed �hereby. <br />D:�;e. <br />Signature ol Applicanl Date <br />WORK AUTHORILED BY THIS PEflMIT MUST BE STARTED WITHItI <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAY� DURATION. <br />