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Data���� <br />Application For <br />PUBLIG VI/ORI�CS P�ERI4AIT <br />Print or Type Only <br />Owner <br />City <br />PobLc Works Pperm-l—1 a� T� 5� <br />aiae� ucoi. + SZJ v.G� <br />Pu0licWo�ksFao $ <br />Talal Feo <br />Less AppL Fen Paltl $ <br />Bolance Oue g <br />Phone <br />���'l�� <br />Applicani �1��ling Address City Zip Phone <br />Describe Proposed Work T�_� �� •1 " 1����1�� f��"J� — <br />Project Addross (if known) <br />Attach four (4) cupies of plans lor nroposed work - Draw to scale and note the lollowing as applicable: <br />n Properry Lines <br />• Outline and dimensions of all eRisling and <br />proposed svuctures on ihe lot <br />• Existiny and proposed utililies <br />PERMIT CONDITIONS <br />• Canlerline ol street <br />• Indicale Norlh <br />• Show any proposed grading ch�nc,es <br />• Show measurements <br />1. All calls (or in�peclion shall be made 24 hrs. in advance - phone 259•881 S. <br />2. All worN shall be parformed in accordance with ihis permit and current Ci�y of Everett Drsic�n and Constr�ction <br />Standards and Specifications. <br />3. Call Location Underground Service 4A hrs. before you dig. TOLL FREE NUP.�BER 1-800-424-5555. <br />��/G�G/C GJO�'•FS f�E,c-'i���% /+IUT �'EG�Ui.�E>J '5��� 7 <br />� %��="' `" <br />Approved lor Constructi�n <br />FINAL INSPECTION <br />Approved as Construcled <br />everett PUBLIC WORI<S DEPARTfdENT <br />� 3200 Cedar Slroet <br />Everett, WA 98207 <br />Phone; 259�6815 <br />Date <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold 2nd save harm- <br />less ihe City of Everett from any and all claims for damages, cosis, <br />er.penses, or caGses of action that may arise because of instaltation <br />and maintenance of the improvement or other right-obway use hereto <br />applied for and further agrees to remove same upon notice from the <br />Ciry and to replace public properry damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY TFiIS PERMIi A1UST BE STARTED WI'lHIN <br />�180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEfiMIT MAY BE <br />CANCcI.LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />