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Date / • " <br />Application For <br />I�Uf�LIC \NORKS F�ERIIAIT <br />Print or Type Only <br />Owner <br />Mailing <br />Mailing <br />PYbIiC WOrhi Peimlt t l/ <br />Blelp. Dent. a_3•� 7 6.. <br />GL, <br />PueiicWorksl'ea 5 <br />101a1 Fva <br />Lar. Bpnl. PoP �'aiU S <br />Balnnco Duc S <br />Phcrie <br />rnone <br />DescribeProposedWork �r1Ari�i�.IL 'JrSL!1—=uti.U�—�— uf������ - <br />Proiect Address (il known) <br />nnach four 141 cooies ol plans for proposed work • Draw !o scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on ihe lot <br />• Existinp and proposed utilities <br />• Centerline �f street <br />b Indicate North <br />F Show any proposed grading changes <br />H 5how meaeureinents <br />PERMIT CONDITIONS <br />1. All calls (oi inspection shall be made 2a hrs in advance - phone 259•881 5. <br />2. A!I work shall be pe� lo�med in accordance wilh !his permit and current Cily oF Everett Design and Constructiun <br />Standards and Specilicalions. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />%�i/yL/L <br />� n2 <br />lor Conslruction <br />G�oi'e_s <br />Tjis <br />r"�E.c'`i ; % i%G,�=EqO�/ TSSUE.O <br />S-�7� �_ /, ��8 7 <br />( ^ �� <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT / <br />� 3200 Cedar Slreet i/ <br />Everett. WA 98201 [ <br />Phone:259�8815 <br />ACKNO'NLEDGEMENT OF COGDITIONS <br />� <br />� <br />The undersiqned owner/applicanl hereby agrees �o hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action may arise because of installation <br />and maintenance of lhe imp � 61 or lher righl�ohway use hereto <br />applied for and further e rem e same upon notice irom Ihe <br />Ciry and to replace pu p ert m�d thereby. <br />�t�re of AFP � ant � / Date <br />WORK AUTHf��ZED TIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYSl OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILI3ENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED �Y THE CITY UPON ANY STOPPAGE OF V✓ORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />