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Date�,�� � <br />Application For <br />�'UBLIC W�RKS PE�iMiT <br />Print or Type Only <br />� <br />Pu�llc Works Permi� s _ <br />BIEg. Dept + <br />Publlc Works Fca S <br />Totel fea — <br />less Apo' Feu Gala S <br />�olance Duo <br />Phonr: <br />_<�7/ -855� <br />Phone <br />Project 1,ddress (il known) <br />Attacl�, iou, (4) copies ol plans for proposed work - Draw to scale and note the tollowin� as applica6le: ' <br />� Property Lines a Centerline of sVeef <br />• Outline and dimensions of all existing 2nd • Indicate Norlh <br />proposed siructures on the lof • Show any proposed giading changes <br />• Existin� and proposed utilities • Show measuremen�s <br />PERMIT CONDITIONS <br />7. All calls for inspectior. shall be made 24 his. in advance - phone 259-$81 5. <br />2. All wor4 shall be pertormr,d �n accordance with this Fermit and current City o( Evei^_tt Design and Construction <br />Standards and Specilications. <br />3. Call L�cation Underground Service 48 hrs. belore you Aig. TOLL FREE NLiMOER �-p00•424-5555. <br />�/ <br />��c'iG L�O/'�-<S' f��-i rv� _ .,r�C�; � i�r'=e� � ii �� /� <br />Approved for Construction Date <br />FINAL WSP'eCTION Date <br />Approved as Construc�ed <br />everett PUBL!C WGRKS DEP�R7MENT <br />� 3200 Cedar Sireet <br />Eve�ett, WA 08201 <br />Phone: 259�]815 <br />/Z/'�8� <br />� , <br />L. . % ;� , <br />ACKNOWLEDGC-MENT OF CONDITIONS <br />W <br />� <br />N <br />� <br />U <br />The undersigned owner/applicant he� ehy agrees to hold and saee harm� <br />less the City of Everett from any and all claims �or damages, costs, <br />expenses, or causes of action that may arise because of instzllalion <br />and maintenance of ihe imFrovement or olher righ�-of-way use hereto <br />npplied for and further agrees to remove same upon notica trom ihe <br />City and to replace public property damaged thereby. <br />Signstufe of Applir.ant Dsis <br />Vv'ORK AUTHORIZED BY THIS PERMIT MU.�.T BE STARTED WITHIN <br />780 DAYS OF DATE PERIvtIT IS ISSUED AND 'fHEREAFTER IS TO <br />BE GILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPhGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DUHATION. <br />