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Date�?�11(C�c� <br />Applicati0n For <br />PUBLIC V1/nRKS PERMIT <br />Print or Type Only <br />Applicant <br />.tt✓p/0 �L(/�U� <br />Mailing Adtire9s City <br />Li/'/7-l�n,� � <br />Mailing hddress City <br />PaencWo�tsPwmpd.p ���p _ <br />BmpDeo�-+.1Lp _/I kJ0 __ <br />Pubi�c Works Fea <br />Tolal Fce 5 — __ <br />�e55Ap01. Poe PaiO 5 <br />Balance0ue 5 <br />Zip Phone <br />DescribeProposedWork �P�(�^A��(j�✓n4L1G;+!' '�%_ ilforT� f,prd%dn �lC/lr�.�� ___ <br />Prolect Address {if known� <br />Atlach four (4) copies ol plans tor propcsed work - Draw to scale antl note the following as <br />• Property Lines <br />• Ouiline and dimecsions ol all exis,ing and <br />piopos: d structums on the lot <br />• Existing and propa:ed ulilit:es <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed gradinc� r.hanges <br />• Show measuremenis <br />PERMIT CONDITIONS <br />t. All calls for inspection sh.:li tre made 24 hrs. in advance - phone 259•$$10. <br />2. All work shall be performed in accordance wilh ihis permit and cu« ent City of Fveretl Desic�n and Construction <br />Standards and SpecBications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NLIMBER 1•800-424-$555. <br />/- l/f�G /C %Ud.�'-.�f' ���/�7�� ' if/OT i«4l/i�.�-.D <br />Approved lor Consiruction <br />FIPJAL INSPEGTION Date <br />Approved as Constructed <br />everMl PUBLIC Y`JORKS DEPAR�TMEqT <br />� 3200 Cedar Street <br />�verett, WA 98201 <br />Phone: 259-8010 <br />. � <br />ACKIJOWLEDGEMENT OF CO'JDITiONS <br />W <br />� <br />� <br />� <br />r� <br />• <br />� <br />� <br />Th2 undersignetl owner/applicant herety arvees to hold and save harm- <br />less the City of Everetl Irom any and atl claims for damac�es, cos�s. <br />expenses, or causes of action that may 2�ise because of installalion <br />and mainlenanr.e of Ihe improvement or other rinht�ohway use hereto <br />apDlied for and furiher agrees to remove same upon notice Irom ihe <br />Ci1y and to replace public property damaged thereby. <br />Sic�nature ci Applicant Date <br />WORK AUTHORIZED BY Th'iS P'cRMIT MUST BE STARTED WITHIN <br />180 DAYS OF nATE PERMIT IS ISSUcD AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. iHIS PERMIT A;tAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WCRK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />