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Date�Lr `� I .`"'., N�,�,�,�v�o,�sP�,m� ., -�--ff — <br /> �_/� ��;" <br /> Applicaticn ro� � �9 DeP' � Q'�Jwl <br /> PUBLIC WORKS PERMIT '°°°°W°�`=`°� --- -- <br /> ,o„�F�� 5_ <br /> iess noni.Fee va�a 5 <br /> oaianr.eDoe S <br /> Print or Type Only <br /> `�Jl�1( ` al (�'e—� <br /> Qw�e� A7ailin�Address Ciry Zip Phone <br /> �\ppliC3n1 Mailinc�Addres5 Ciiy Gip Phone <br /> Describe Proposed Wark _ ���� �� <br /> 1 � � � � <br /> Project Address lif known) �' A �� —�-• — � <br /> Atlach four(4) copies of plans for proposed work� Draw lo scale antl note ihe iollowing as appli le� � <br /> • ProperiY Lines • Ce:�terline rf streel � <br /> • OuUinz and dimensions of all existing and i Indicate North <br /> proposed s�ructures on ihe lo� • Show any proposed grading changes <br /> • Existing and proaosed utilities • Show measuremenis /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 his.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and wrreM City of Hverett Dasign and Consiruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-S�JO-424•5555. � <br /> ���- �s� . p <br /> , <br /> ,�, �� <br /> � �,�z���, i... <br /> � <br /> 0 <br /> a <br /> — <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe City of Everelt Irom any and all claims for d�ma9es, costs, <br /> ezpenses. or causes ol ac�ion ihat may arise hecause ot installation <br /> and maintenance of the improveme.�t or olhe� right-ol�way use hereto <br /> applied lor and luriher agrees to remove same upon notice irom ihe <br /> Approved lor Construction Date Ci!y and to replace public proper�y dam.aged thereby. <br /> FINAL INSPECTION Datc <br /> Approved as Construcled Si9nature of Applicanl Date <br /> WORK AUTHORIZED BY TIiIS PERMIT MUST OE STAP.TED WITHIN <br /> everctt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PEFiMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY E3E <br /> Everett,WA99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 OAYS DURATION. <br />