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Datesl2418I <br />Application For <br />PUBLIC N�ORKS PERMIT <br />Print or Type Onlv <br />�� 83Z <br />r�eecwo�ksva�ma• _1��� <br />eiao. o�u�.. <br />Pu�lic 1YorMa Fee ,�� <br />Totel Fee S ,�n�� <br />Le5sAp0�� Fee PaiE S � <br />Oal,�ncuDu� S ��� <br />Atlantic RiChfield Cnmg3nv S15 Cn�rth Flnmar St_� T.nc Anb+alnc� fA Q0071 R79_5579 <br />Owner Mailing Address Ciry Zip Phone <br />Applicant <br />Describe Proposed Work <br />Pr! �ect Address (if known) <br />Mailing Address <br />Zip <br />Attach four (4) copies of plans lor proposed work • Craw to scale and note the following as apPlicable: <br />• Property Lines <br />• Outline and dimensions ot ail existing and <br />proposed structures on the lot <br />• Existing and proposed u:ilities <br />PERMIT CONDITIONS <br />• Centerline ol street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everell Design and Construction <br />Standards and Spacitications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />`-�' %.,� %�j��,,.�d ���s� �-/�� 6 -io ��� <br />Date <br />IZ3 �P,' <br />FINAL INSPECT�ON I � � <br />ApUrovedasConstru��.ad \ <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />�" <br />� <br />� <br />a <br />The undercignetl owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Iroin any and all claims for damages, costs, <br />expenses, or eauses ol action that may arise because ol installation <br />and mainlenance ol the improvement or other right�ol�way use hereto <br />applied lor and lurlher ac�rees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />S. G� 6 //-8� <br />Signalu Applicant Date <br />WOR AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE710N. THIS P[HMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />