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C1ate �� "� O � <br />Applic��ion For <br />PUBLiIC WORFC� PE�iM{T <br />Print or Type OnVy <br />, / � `�� C��— � <br />Owner <br />� [l.l��_ <br />Anplicant <br />M1lailir.9 Address <br />.— �j� <br />Descrite Proposed Work �re�Y_lll j 1 �- -�%� Y`• <br />Project Address (if known) <br />C_-�/C i . � - <br />City Zip <br />c��y ���, <br />Atlach lour �4) copies of plans for proposetl work - Draw te scale antl note ihe following as applicable: <br />• Pruperty Lir�es <br />• Outline and dimensions ol all existing and <br />proposed structures on the Ict <br />�� Exisling end proposed utilities <br />FERMIT CONDITIONS <br />r�,�„�, �:�o,�;�, r,,�,,��� , � <br />ome. oe❑�.. <br />c�/� ` � — C � <br />Puboe Woikg Feo <br />Ta1alFoo S <br />Less �ppl Fev PaIJ $ <br />Balanw 7ue $ <br />• Cenlerline nf streel <br />i Indicate North <br />s Show any proposed grad�ng changes <br />• Show measurements <br />Phone <br />1. All calls for inspection shall be made': 1 I�rs. in aavance - phor,? 259•881 5. <br />2. qll work shall be pertormed in accordarce with this permit and current City of Everett Design and Construction <br />Stand�rds and SGecifications. <br />3. Call Location Underground Service 48 hrs. before ynu ti:�. TOLL FREE NUMBER i-800•424•5555. <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Cons,ructed <br />everett PUBLIC WOi3K8 DEPARTMENT <br />� 3200 Cedar Streat <br />Everett, WA 9E Y07 <br />Phone:259-8GI5 <br />� <br />�r����J���� <br />i���a � <br />L��� <br />ACKNONJLEDGEh1ENT OF CONDITIONS <br />W <br />H <br />�w <br />— / <br />�i <br />• <br />� <br />O <br />The undersiyued owner/applicant hereby aqrees lo hold and save harm- <br />Iess the City of Everett irom any and all ciaim:, for damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and v.aintenance of the improvement or other ri9ht-of-v+ay use nerelo <br />p'— applied for and fur�hcr aqiees to remove same upon no�ice Irom the <br />City and lo replare public propertp damac�ed thereb�. <br />Uate I <br />Signature ot Applicant <br />Datc <br />'NORK AUTHORIZED BY THIS PERMIT MUST 6[ STHRTED �VITfiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />EE DILIGENTLY PURSUED TO COMPLETIGN. THIS PERMIT MAY BE <br />C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />