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• � �I <br />•_ - • <br />n, <br />Applicalion For <br />PUBLIC WORKS PERIIAIT <br />Print or Type Only <br />Mallmg Atldress <br />Descnbe Proposed Work <br />Project Address li! Nnown) <br />Attach low (4) copies ol plans lor proposed work - Draw to scale <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />propasetl structures on ihe lot <br />• Ezisfing and proposed utilities <br />� <br />Ci�y <br />T <j;��4 * .: <br />o,�K.�-��,;.��, <br />.� � <br />:,r,;. <br />� <br />hb�,c Wo�ha Parmn �{ <br />61ng DeO�. • _ 1� <br />Pubbc WOtFb FeB <br />iotni Fee S <br />LessA00� FaeCai� � <br />Balance Uua 5 <br />� <br />note the lollowing as applicable: <br />• Centerline of street <br />• Indicale Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />Phone <br />PERMIT CONDITIONS <br />1. P.1I calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 t�rs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />/�(/3lc� C.c�cnf''v �.zz-�,�c f ��� ��'«`"c� /, <br />'����ovf''_ <br />�' //—,99 <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Consfructed <br />everett PUBLIC WORKS OEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />Phone: 255�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save ha�m• <br />less ihe City of Everett Irom any and all claims br damages, cosis, <br />expenses, or causes ot action ihat may arise 6ecause ol insfallation <br />and maintenance ol the improvemenl or other ngh4obway use hereto <br />applied for and lurther agrees to remove same upon notice Irom Ihe <br />Gity and to �eplace pubhc Property dam2ged thereby. <br />S��n��atwe of Appiicant <br />WORK AUTIIORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 D�YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />