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Date� � l <br />Appllca�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Descrlbe Prppoead Work rnN� N� �qQt±TC✓t kli�f!!�3 <br />Prolect Add�eee (il known) <br />( <br />PuMic Worh� Permil • —�— <br />Biap Dapt • — <br />PuEncWorw�Fee s <br />inl�l iee <br />lee� �ppl Poe P�iE i_ <br />IB�IenceUue �_ <br />S�' ,l�i�,Llt,��a.. wr9 9 s <br />71p Phone <br />Attach lour �4) copies ol plens lor p�oposad work • Draw to er.ale eiid note the lollcwing as epplicable: <br />• Property Llnas • Centerline ol alreal <br />• Oulline and dimenr.lonn ol all exletln6 end • Indicete North <br />propoaed etructuree on Ihe lol • Show eny proposed pratling chengea <br />• Exlatinp end Dropoaed utilillas • Show meaeurementa <br />PERMIT CONDITIGNS <br />1. All calls for Inepectlon shell ba meda 24 hra In edvenco • phone 259•8815. <br />2. All work shall be pertormetl In eccordence wlth thle permit end current City ol Everett Oeslpn and Conatrucllon <br />91end�rde end Specllicellona <br />3. Call Locetion Underground Servlce 4B hra. belara you dig. TOLL FREE NUMBEN i•800•424•5555. <br />P�a�.� C+JI�.�'.CS f�.t_i=+iT �'%T iS'E��t-v,c'FU <br />Approved for Conatructlon Dete <br />FINAL INSPECTION Dule <br />Approved as Conetruclad <br />�rery PUBLIC WORKS DEPARTMEhT <br />� 34'10 Cedar Sireet <br />Eve'�dt, WA 98201 <br />Phone: 259-8815 <br />/, � <br />�" C 1i+,_' <br />�//,y 7 <br />ACHNOWLEDGEMLNT OF CONDITION3 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The underelgned owner/eppllcent hereby agreee to hold and eave harm• <br />less the City ol Everetl Irom eny and ell cle!ma lor demege& coats, <br />expenses, or ceuees of ecHon ihet mey erlee beceuse ol Inetelletlon <br />end ma:ntenence of the Improvemanl or other righl•ol•way uee he�eto <br />applled lo� end lurther agreec to remove sema upon nollca Irom the <br />Cily and to raplace public prouerty demaged thereby. <br />Slpnature ol Applicant Dete <br />WOHK AUTHORIZED BY THI9 PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILI(itNi�r PURSUED TO COMPIETION. THIS PERMIT MAY BE <br />CANCELLED B1' THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />