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�'� � ' 7 <br />Date �'� O <br />Applicahon For <br />PiJB�IC W0�3KS i�F_RMIT <br />Print or Type Only <br />�k- <br />City <br />Vi,m�.c :�mw•. N�.�m�i e �_ <br />�inq Dca�. . `��_� _'J � =�— _' <br />— � __'_--_-- <br />Puebc warxa Feo <br />loql Fpe S .—_ <br />Le55 FnC' f ec Vm� 5_ <br />[�:�Idn[C [luC J _ <br />�'`. ��rl.�'J«�'. <br />Zlp Phone <br />C�ty Zip Phone <br />� <br />Descri6e P�oposed VJork _ . � �� ����I���« � �( 1.�� ����v�� _- <br />Project Address �if known) <br />A�tach tour �a) copies of plans for propose.d work - Drav.� lo scale and note the Wllowing as apPlicablei <br />• Property Lines <br />• Outline <ind dimension^, of all existing and <br />proposed slructures on Ihe lot <br />• Ezistiny and proposed utiGties <br />NOT <br />• Centerline of street <br />• Indicale Norih <br />Y Show any proposed grading changes <br />o Show measuremenis <br />P�RMIT CONOITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2 All �sork shall be performed in accordance wilh this permit and current Cily of Everett Desiyn and Consiruction <br />Standards and :�pecifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•S00•424•55.ri5. <br />Approved for Consiruction <br />FINAL INSPECI.ON <br />Approved as Constructed <br />eveietl PUBLICWORKSDFPARfMENT <br />� 3200 Ceda� Street <br />Everett. WA 38201 <br />Phone',259�8810 <br />�� �� <br />''- ���� <br />,,� _. .� <br />.:;_ _, ;,.� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />1� <br />� <br />� <br />O <br />The undcrsigned owneriapplicant here6y agrees to hold and save harm- <br />less Ihe City of Everelt from any and all claims lor damages. costs. <br />expenses, or causes of �ction ihat may arise becai.�se o! installation <br />and maintenance of Ihe imp�ovemen� or other righPol�way use herelo <br />applied lor and fur�her agrees lo remove same upon nutice Irom the <br />Date Clty and to replace public property tlamaged Ihereby. <br />te <br />Si 7nature ol Applicant Date <br />WORK AUTI�ORIZED BY THIS PEfiM1T MUST BE STARTED WITHIfJ <br />180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTEf7 IS TO <br />BE DIUGENTLY PURSUED TO COMPLETION. THI� PERMIT MAY BE <br />CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THI� <br />PROJECI OVER 90 DAYS D�RATION. <br />