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Datei�(��d`g' <br />Applica�ien For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />C <br />Mailin9 Address <br />C�ty <br />" ����n��� �Vr,ws r�imnp.p �c -- . <br />u�n�i o�,ni . .—D_/-�oZ{+��U_._... <br />Pa�i�cWorFsfce � <br />,o,�, Fea s _—_ <br />iessanni inPPa�� S -- <br />Baian�n, nm. S <br />Q�zo 3 dS� -<19�� <br />Zip Phone <br />Zip Phone <br />Descnbe Proposed Work /,��i �%f /_'�QYYiO�I /1��[yl � %PI'i'��OU_J�� ___ __ <br />Pmjecl Address Iil known) �wv u rr i_�y�_y_ <br />Atlach lour 14) cupies of plans lor proposr.d work - Draw lo swle antl note the lollowng as applicable: <br />• Property Lines <br />• Oufline and dimansions ol all existing and <br />proposed StruCtures an the lal <br />• Exisimg and proposed utildies <br />4 Centerline ul sl�ae� <br />• Indicate Norih <br />• Shcw any proposed grading changes <br />O Sho��a measuremenis <br />PERMITCONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in eccordance with this permit and current City ol Everelt Design and Construction <br />Standards and Specifications. <br />3. Cali Locetion Underground Service 48 hrs. 6efore you di�7. TOLL FREE NUMBER 1•800•424•5555. <br />�JpZ,�1• j�2�n.v/C CD�.�l�+-ed c�wu�ti/ CC.cL�%c.li� G�".., <br />—/ � Z <br />Apprwr.d lor Construction Date, <br />FiNAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC'.NORKS DEPARTMENT <br />� 3200 Cedar S�reet <br />Everelt, WA 98201 <br />Phane:259�8810 <br />uT�e <br />ACKNOWLEDGEMENT OF CONDI710NS <br />7he undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cdy ol [verett Irom any and all claims lor Aamages, cosis, <br />expenses, or causes of aclion Ihat may arise because of installalion <br />and maintenance ol the improvement or other rlghbobway use hereto <br />applieA �or anA lurthar a9rces to remove same upon nolice irom ihe <br />City and to replace pubhc proPerty damaged thereby. <br />nature ol ApPlican� <br />WORK AUTHORIZED BY THIS PERMIT MUSf BE STARTED WITHIN <br />180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELL[D BV THE CITY UPON ANY STOPFAGE OF WORK ON THIS <br />PPOJECT OVER 90 DAV3 DURATION. <br />