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,-� <br />Date���'� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />� <br />Applicant <br />D: scribe Proposed Work � �) r�tll.l�� r� [a�n � <br />Proiect Address (if known) <br />Zio <br />Pubiic Works Permil • n <br />Bltld DopL • � ��%.� <br />' / _ <br />Pabi'ic �Yorka Fm <br />Totni Faa 5 <br />Loss ApO� Fae Pn10 $ <br />Bolance Oua $ <br />Attach lour (4) copies ot plans lor proposed work • Draw to scale and note tho-tollowing as applicable: <br />• Propsrty L!nes .• Centeriine ol street <br />• Oulline and dimensions o( all existing and • Indicate North <br />proposed structures on the lot A Show any proposed grading changes <br />a Exlsting and proposed ulilities M uhow measurements <br />Phone <br />PERMITCONDITIONS <br />1. All calls for Inspeclion shall be made 24 hrs in advance - phone 259•881 5. <br />2. All work shall 6e performed in accordance with this permit and current City of Everett Design and Conslruction <br />Standards and Spec��ications. <br />3. Call Location Underground Service 48 hrs. betoro you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/�(J/3Gif GJO.e.CS ���/�rT /Vn% �EqUi.�'EO <br />Approved for Construc�ion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Street <br />Everett, WA 90201 <br />Phone: 259-887 5 <br />8 ��-87 <br />�� <br />ACKNOWLEDGEMENT OF ;ONDITIONS <br />The undersigned owner/applicai,t hereb> agrees to hold and save harm• <br />less the City ol Everetl Irom any anr all claimo for damages, wsts, <br />expenses. or causes ol action that may arise because of inslallalion <br />and maintenance ol the imnrovemen� or olher righFof way use hereto <br />apphed for and Wrther agrees to re��ove samn upon notice irom the <br />City and to replace pub'ic propert� d.�maged thereLy. <br />Signature ol Applicant Date <br />WORK AUTHORIZEJ BY THIS PERMIT MUST BE STARTED WITHIN <br />l80 DAYS OF DATE PER�11T �S ISSUED AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEH 90 DAYS DURATION. <br />