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Date_—t7�SL0 � <br />Application For <br />PUF3LIC WORKS� PERMIT <br />Piint or Type Only <br />owner - <br />� � <br />Applicant <br />Mailing <br />Mailing <br />Descnbe Proposed Work ��'I-� � �.1—`= � — <br />Prolect Address (if known) ��� �� 1 � �= <br />1 <br />Attach lour (41 copies of plans for proposed work - Draw lo scale and <br />• P:operty Lines <br />• OuUine and dimensions of all existing and <br />propased SUuc�ures on ihe �ot <br />• Existing and proposed utilitir.s <br />n„�i,c wm�s ae�yr{o�y�ry�_� <br />���b Den�.• .�1-1- — —.— - <br />Publ¢ WO�kS FCC S <br />iO�fll FCC <br />l. .• aooi Fo.• Prn,f .S <br />pal,n. �• D�.��. $ <br />� <br />Zip <br />Ihe tollowing as appGca6le: <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />�I7 <br />PERMIT CONDITIONS <br />1. All calls (or inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be peAarmed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-E00•$24•5555. <br />�1zc� �`T !�o � �:iJ � (ztY� <br />�Cts�-�- �°iee�� <br />�� -Z�� ��l <br />��uG...�il/��- ��- ���.,.,��r� - <br />D�� � cv2z`'� �,c.,� � �'ati c.�a.�.� �u.�-z` 6_.� <br />��� �e �!� ���''' �'��'�J� •_b'c� AGKNOWLEDGEMENT OF CONDITIONS <br />?pproved lor Canstrudion <br />� <br />O <br />♦�A <br />V/ <br />O <br />a <br />��/y—ZG <br />The undersi9ned owne�/applicant hereGy agrees to hold and save harm- <br />less the City of Everell irom any and all claims for damages, costs. <br />expenses. or causes of action thal may arise hecause of installation <br />and maintenance of the improvement or other righl-obway use hereto <br />applied for and further agrees to remove same upon notice Irom Ihe <br />Date City and to replace Public properry damaged thereby. <br />FINAL INSFECTION Date <br />Ac�roved as Constructed <br />I ev�>ret[ PUBLIC WORKS DEPARTMENT <br />I,� 3200 Cedar Street <br />Everett. WA 9820t <br />�� Phone:259-8810 <br />Signature ol Applicant Datc <br />WORK AUTIIORIZED BY THIS PEflMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NT�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 />