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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />TO POSTING ����z�'�'� <br />Print or Type Onry �'` <br />Mailinc nrdress' <br />rn:,�una naaress <br />l;ii)' � �/ � 7_i� <br />� �� <br />� <br />c„� z�p <br />� � � <br />Puehc Wo�hs Pormll a . Z� _ <br />9h19 DeO�� ^ <br />P��� I��; HIp�NS FCP. <br />1utelFee $ <br />less \pW. Fao Pa�tl g %� �^ <br />Baiancr Duu � �I <br />> ' l � (�d✓ �� <br />Phonr. <br />W_�g-616( <br />Describe Proposed Work ____���!_LL�___N—�� --__C/_��Y 3 "�����3 <br />c� <br />-------- :- �---- <br />Project Address lit known! <br />Attach four (4) copies of plans foi P�ol�used wurk - Drav: to .catrr ano rote �ha !oilowing as applicahle: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on ihe loi <br />• Existing and proposed utilities <br />• Gentr.rlinn of street <br />• Int!ir3P' No��h <br />• Shov.- any r.reposeA i�radmg r,hanyes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Undergiound Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />�• �rotr ox� e 0►?�d � � <br />� — - <br />C�� .�nS�ru�1�`r <br />FINAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />a <br />The unAer"aned owner/appl�crnt hereby agrees to hold and save harm- <br />�� less ;he City ol Everelt Irom any antl all claims tor damages. costs. <br />� e•penses. or causes ot action Ihat ma/ arise betause of installation <br />y and maintenanr,e o! the improvement or other righFof-way use hereto <br />� ac.p��er; lor and lurther agrees to remove same upon notice irom lhe <br />� <br />i C��ty �inn iri rep bhc p�onerty damaged ihereby. <br />1' Signature of Applican. �^�a�� <br />iIh�ORK AU7HORI2ED BY THIS PERMIT NUST BE STARTED WITHIN <br />I1H0 DAYS OF DATE PERMITIS ISSUF.O AND THEREAFTER IS TO <br />SE DILIGENTLY PUHSUED TO COMP! ETION. THIS PERMIT MAV BE <br />ICANCELLED 8'f THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.�ECT OVER 90 DAYS DURATIGN. <br />