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Date � _I I'—v ' <br />Applir.alion For <br />PUBLIC WURKS PERMIT <br />Print or Type Oniy <br />Mailing Address <br />c�ry <br />1'uli��!_1Y�1.�5 Vnrn ��J1 J <br />pinn �eoi . ._ �_ �C./1.. 0� <br />Vuftlm \Vor4fi 1 fb <br />latal[en � __ <br />Less Appi (nn VaW S <br />udl,lnce �uc $ <br />Zip Phone <br />Describe Proposed Work �` �� � � u � LL� � . <br />Project AdAress (il known) <br />Atlach lour 14� copies ol plans loi proposed work � Oraw lo scale and nole <br />• Propeiiy Lines <br />• OutGne and dimensions ol all e■Istmg and <br />proposed slructures on the lol <br />• Existing and proposed utildies <br />ihe lollowiny as applica6le: <br />• Centeiline ol street <br />• Indicale North <br />• Show any proposed gradmg chanyes <br />• Sh 7w measuremenis <br />PERMIT CONDI710NS <br />1. All cells for inspection shall be madA 24 hrs. in advance • phone 259•8810. <br />2. All work ehall be perfo�med in accordance with ihis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 4B hrs. beforr. you dig. TOLL FREE NUMBER 7•860•424•5555. <br />Approved lor Construclion <br />FINAL INSPECTION <br />Approved as Construcled <br />evcrelt PUBLIC WORKS OEPARTME4T <br />� 3200 Cedar Street <br />Everett, WA 992C I <br />Phone: 259�8810 <br />�-��/�� <br />�.�r- �v- <br />ACKNOWLLOGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />� <br />The undersigned owne/applicanl hereby agrees to hold and save harm� <br />less the City ol Eve�etl Irom any and all claims fer damages. costs, <br />ezpenses. or causes ol action that may arise because ol installation <br />and maintenance ol the improvemenl or other righFobway use herelo <br />apphed lor antl lurlher agrees lo remove same upon notice Irom thn <br />Date GIy anA lo replace uublic pronerty damaged ihereby. <br />Dale _ <br />Si9na�ure ol ApPhcant Date <br />WORH. AUTHORIZED BV THIS PERMIT MUST BE START[D WITHIN <br />iB0 �AVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />GANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PROJFCT OVER 90 D�VS DURATION. <br />