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��� <br />D �C <br />��� <br />�H� <br />Ox0 <br />�fnH <br />� O � <br />O I-iG <br />h^ �P <br />+. V �] <br />t" y 'Z <br />ra y <br />gy <br />�e� <br />�i. y t�i� <br />HOfn <br />�� <br />Daie—_���"�G <br />ADP��Calion For <br />PUBLIC N/ORKS PERMIT <br />Prinl or Type Only <br />a�m�� w�n. r���n • `'�S� - <br />Biop oen� � / -- <br />Pubbc Worxe ieo s --T"J� r� � <br />totelfec �_/ <br />Lese Appl Fee P��E s� <br />oaience Due S O — <br />C? %�ox �2317 �'Ve�� <br />Jwner <br />Mailing Address <br />Describe Proposed Work <br />Prolec� Address (if known) <br />Attach lour (4) copies oi plans lor proposed work - Draw to scele and <br />• ProPerry Lines <br />• Outline and dimensions of all existing and <br />proposP.d siructures on ihe lol <br />• Exislin9 and proposed utilities <br />��M <br />following as applicat�le: <br />• Centedine ol street <br />• Indirate North <br />• 5how any proUosed grading changec <br />• ShoW measuremen�5 <br />IINE <br />Phone <br />PERMIT CONDITIONS <br />1. All calls tor inspeclion shall be matle 24 h�s in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with Ihis permit and curreM Ciry ol Eve�ett Design and Conslruction <br />Standartls anA Specilications. <br />3. Call Location Underground Service 48 hrs, betore you dig. TOLL FREE NUM�ER 1•800•424•5555. <br />�,y.���JYd�''c'���.vIZS C��-fU- <br />�� <br />FINAL INSPEGTION / � x <br />ApU��ved as Constructed � � U <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett. WA 98201 <br />Phone:259�8815 <br />Date <br />�j l� E'� �� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />Y I <br />O <br />a <br />The undersigned owner/applicant hureby agrees Io hold and savc harm� <br />less lhe Ciry ol Everett irom any and all claims lor damages, costs, <br />expenses, or causes of aclion Iha� may arise because ol installation <br />and maintenance ol ihe improvement or other righl-of-way use hc.reto <br />applied for and turther agrees to remove same upon notice irom the <br />City and tu replace public property damaged thereby. <br />a�/� -� s � /i -; /�r� <br />Signa ure of App�IcanY� ' ate <br />WORK AUTfiORIZEO D'i IHIS PERMIT MUST BE STARTED WITHIN <br />100 DAYS OF DATE PGRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PEAMIT �AAY BE <br />CANCELI.ED BY THE CITY UPON ANY STOPPAGE OF WORK JN TIiIS <br />�ROJECT OVER 90 DAY;i DURATION. <br />