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oetel�� _o< <br />�� 5 <br />ACPllca' �on F o� <br />PUBLIC WOHF�S PERMlT <br />Print or Type Only <br />��Zll�.� (�i 7��1 �191 � � �1s <br />Owner Mailing Atldre ss <br />� <br />iling AAtlre^s <br />Cily <br />Zip <br />Zip <br />Puoor. Wo�w� Vermn • <br />` l ` __ <br />B�Up Dep� • _._ <br />PuE�nWorw�fee t <br />T�t�l fee <br />LMaApO� FaePeH f <br />B�I�nceDue S <br />Deecribe Propoaed Work _. 1�� !/��— 5.11 L�� _ <br />Prolect AECreee Ut known) <br />Altech lour (4) copies of plans �or propoeed work • Draw to scele end note Ihe Iollowing xs a��plicable: <br />• Property Lines • Centerline ol sVeet <br />• Outlfne end dimenalona ol all e:islinp end • Indicete Noilh <br />proposBd s�ruClurEe on Ihe lo� • Show any propoeed g�eding changes <br />• Exlstinp end proposed utllitlee • Show measuremenls <br />PERMIT CONDITIONS <br />1. AII calle �or Inepeclion ahell be mede 24 hrs. in edvence • phone 259•8810. <br />2. All work ahell be perlormed In eccordance with thla permit end current City ol Everetf Deslpn end Conntructlon <br />Standerde end Speclllcatione. <br />3. Cell Locallon Untlar�round Servir.e 4G hre. before you dig. TOLL FREE NUMBER 1•800�424•5555. <br />I �l�'r� ��1_� ��(G��C� / /;� �8 <br />�''� <br />Approved lor Conetructlon Date <br />FINALINSPECTION Data <br />ApDroved ee Conetrucled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3400 CMar Stroet <br />Evarett, WA BB201 <br />Pnone:25B�BBtU <br />ACKNOWIEDGEMENT OF CONDIfIONS <br />W <br />H <br />! <br />� <br />The undersigned owner/applicanl hereby agrees to hold and eave herm- <br />�ess the City of Evereti Irom any end a�I claime lo� demeges, toste, <br />e■penaes, or ceusea of action Ihel mey erlae becauee ol Installetlon <br />end malntenanca ol Ihe improvement or olher ripht�ol�way uee hereto <br />applled lor nnd lurther agrees to remove same upon notice irom Ihe <br />City and to replace publlc property dameped Ihereby. <br />Signeture o� Applicanl Aate <br />WORK AUTHORIZED BY THIS PERMI7 MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE CITV UF011 ANV STOPPAGE OF WORH ON THIS <br />FROJECT OVER 90 DAYS DURATION. <br />