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Da!e__,L✓�� <br />Applicetion For <br />PI�BLIC VIi�RKS PERMIT <br />Print or Type Only <br />Meilmg Address <br />Deecrlbe Propoeed Work <br />Pro�ed Addreee pl known) <br />� <br />� <br />Pu1:Lc WmMs Germil • <br />B�aa Oepl � <br />� �� _ _ <br />Publ¢ WorM Fee i <br />Td�l Fee <br />�� �pPl Fne PuC S <br />B�lence ou+ <br />At1acA lour (4) copiee ol plens lor proposed work • Draw to �cale and note the iollowiny es epplicable: <br />• Property Li�es • Centr.rline of strnet <br />• Outline end dlmensions ol ell exieting end • Indir.ale North <br />propoaed elructures on the lot • Show eny propoi fd grading changes <br />• EKiatinp end propoead utilitles • Show ineesuiements <br />�'�/-3G.�_di'o�� <br />PERMIT CONDITIONS <br />1. All calls lor Inspection shall be made 24 hrs. in edvence - phone 259•881 5. <br />2. All work shell be perlormed in eccordance with this permit nntl current Clly of Everett Desipn end Constme!wn <br />Stenaerda and Specificationa. <br />3. Call Locetion Underground Service 48 hra. belore you di8. TOLL FNEE NUMBER 1•B00•424•5555. <br />/vd��G LcJo.erS �E.'e��T <br />Approved lor Cons�ruclion Dele <br />FINAL INSPECTION Dete <br />Ppproved as Constructed <br />everel� PUB'JC WORKS DEPARTMENT <br />� 3200 Cndar Slreet <br />Evorett. WA 98201 <br />Phone:259�8815 <br />/LU�' .�E'E�C.�ui.cE� <br />���!-9-�9� <br />'1'� <br />4CKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned owner/applicant hereby aprees to hold and sove harm- <br />less the Clty of Everelt Irom eny nnd all clnims lor demegns. costs, <br />eKpenses, or wuses of action Ihal may eriea be^�ause ol inslallalion <br />end meintenence ol Ihe improvement or olher rlght�of�way uso herelo <br />epplied lor and luriher egrees 1p remove same upon nolice Irom �he <br />City anA to replace public property demeped thereby. <br />Sgna!we of Applicant Data <br />WORK AUTfiORIZEO BY THIS FERMIT MUST BE STARTED W�THIN <br />180 DAYS OF DAfE PERMIT IS ISSUED AND THEREAFT[R IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PEHMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />