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DateJ�&- I;J <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P,. Wu4 Pamir <br />suit p.M <br />PUO—kw Ms I.. + <br />TM.' F. <br />L... Alan r« P.A i <br />ftu—ce. <br />cc ,',ml� <br />wnar Mailing Address City Zip Phone <br />AppLcen! �Matinng' Address � II 21p 55 Phone <br />lie <br />Descnb0 Proposed V.ork <br />Project Address lit knownt <br />Attach tour 141 copies of plans for proposed work - Dew to scale and note theidB/owing as appl,table: <br />• Property Lines • Oentedino of street <br />• Collins and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed uuhUes • Show measurements <br />PERMIT CONDITIONS <br />1. All caps for inspection Shall be made 24 has. in advance • phone 259.81310. <br />2. All wark Shell be performed In accordance with this permit and current City of Everett Design and Comin uctfon <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hra before you dig TOLL FREE NNMBER 1.800-424.5555. <br />Approved for ConstrucliUn Date <br />FINAL INSPECTION pate <br />Approved as Consth.cied <br />I <br />iett PUBLIC WORKS DEPARTMENT <br />32006atlu 6201 <br />treet <br />le Everett WA BB201 <br />Phone. 259 8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />N <br />M <br />W <br />O <br />n <br />The undersigned ow^.ecrapplicant hereby agrees to hold a id save harm. <br />less the City of Everett from any and all claims for damages. coals <br />expenses, or causes of acihn that may arise because of installation <br />and maintenance of the impr,vement or other nghl-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />IBC 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 V/ORK ON THIS <br />PROJECT OVER 90 DAYS DLR; TION. <br />