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DateiLJ 4� � <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />Ownr r <br />Malting Address <br />Applicant MadingAddress Gty <br />Ci�(�lif Y/o�hti I���rr Y� j'} / <br />ia��i�� oem • —��C7S(�l_�.. <br />--- -- --- <br />��,d�b� Wo,., �u� <br />lotaivrr $ _ ._ <br />lossl�ppl FeeVaN g <br />�aianreDur $ <br />4�av 3 a�-� � <br />2in Phone <br />Zip Phone <br />DeScribeProposed Work ��' y�-1��� ro �'�=�—1 J���� <br />Prolect Address lif knownl <br />A�tach four (4) copies ol plans for proposr.d work � Draw lo sc��le and nole <br />• ProPPrtY Lines <br />• Outline and dimensions of all exlsting and <br />proposed struclures on Ihe lot <br />• Existing and pr�posed ulilities <br />lollowing as applicable: <br />• Centerline of street <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measuremen�s <br />PERMIT CONDITIONS <br />7. All cails to� Inspection shall be made 24 hrs. in advance • phone 259•8610. <br />2. All work shell be perlormed in accordance with this permil end currenl City of Everett Design and Construction <br />Standards and Sper.ifications. <br />3. Call loca�ion Underground Service 48 hrs. before you dig. TOLL FRFE NUMBEfl 1•$00•424•5555. <br />FINAL INSPECTION <br />Approved as Constructed <br />�+crett PUBLIC WORKS DEPARTMEPIT <br />�3200 Cedar Slreel <br />� Everett, WA9A201 <br />Phone:259�BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />Tiie undersigned owner/applicant hereby agiees to hold and save harm• <br />less the Cily ol Everelt i�om any and all claims lor damages, costs, <br />expenses, or causes ol action ihat may aris� because ol instaliation <br />a'Td maintenance of the improvemenl or othe� nght�obway usr. hereto <br />applied lor and lurthei agrees lo remove same upon nollce irom ihe <br />City and fo replace puhhc U�operty damaqed Ihereby. <br />Siynature of Applicant Dale <br />WORK AUTIiORI�ED BY iHl� PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PlIRSUEU TO COMPLETION. THIS PERMIT MAY BE <br />CANL"ELLED BY THE CITV UPON ANY STOPP.AGE OF WORK ON THIS <br />PROJ[CT OVEF 90 DAYS DURATION. <br />