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Date �� �•`+ � ���' <br />Applicalion For <br />PUBLI� �V�f��.S PE�iN11Y <br />Print or Type Only <br />PubLo Wo�k6 Poimil R . <br />B:a9. DBpt. s ._iifTr? ���� <br />/ <br />PubLc \V.vhs Fes $ <br />To191 Fee <br />LessApc� Fco Pera � <br />BalancoDue a <br />C� �, _ `j s S- GC 9�— <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Worh <br />Proiect Address (if known) ---f�' � � �'-- � � r;,u�Tr u ii� � � �.� , <br />Atlach tour (4) cr,p��.es ol plans for proposed woik • Draw �o scale and no�e the folhwing as <br />• Proper �� L:nas <br />O Outline ;nd dimensions of ali e•.is;ing and <br />propos=d structures on the Ici <br />Y Ezishng and proposed utilities <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed gradinS chan9�s <br />• Show measu�emenls <br />PERPAIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit 2nd current City of Everett Design and Construction <br />Stantlards and Specifications. <br />3. C��II Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />l�/O P��Blic !.c/O�:rs f�i�//�ii iP�n, cUi�E-,� <br />Approved for Construction Date <br />FIN.1L INSPECTION <br />Approved as Conslructed <br />everer. PUBIIC WORKS DEPARTMENT <br />� 320G Cedar Street <br />Everett, WA 98201 <br />Phone 259�8815 <br />���J <br />//-7-fl h <br />ACIQJOWLEDG(=MENT OF CONDITIONS <br />The u�dersigned o� ner/applican� hereby ac]rees lo hold and save harm- <br />less the Ciry of Ev=rett from any and all :laims for damages, cosls. <br />expenses, or cau:es of action thal may 2iise because of installation <br />and maintenance or ihe improvement or ether right�ol�way use hereto <br />applied (or and Iurlher agrees lo remove same upon notice irom the <br />Ciry and to replaca public properry damaged therehy. <br />Signa�ure of Applicart Date <br />WORK AUTHORI2E� HY THIS PERMIT Iv1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUfiSUED TO COMPLC-TION. THIS PERMIT MAY BE <br />CANCELLED 9Y TH8 CITY UPON AiVY STOPPAGE OF WORK ON THI� <br />PROJECT OVER 90 DAYS DURATION. <br />