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Date >>—�g-91 <br />A?plicatio�r <br />PUSLIC WORKS PERMIT <br />Print or Type Only <br />Puobc Warks Peimn • <br />F+�, em�. oeou 91 /28100 _ <br />Public Waeka Fee s <br />Total Fee <br />lasa AoO� Fee PaiE S <br />BalanceDua $ <br />PENNBROOK DEVELOPMENT 906 SE EVERETT MAT.T. WAY EVERETT 9R?OR �47-2307 <br />Qy„�ef Mailing Address City Zip Phone <br />MMI SERVICES INC <br />Address <br />Describe Proposed Work TI <br />Prolect Address (if known) <br />Cit:� <br />Attach four (4) copies ot plans for proposed wurk - Draw tc �caie and note the tollowing as applicable: <br />• Property Lines O Centerline of street <br />• Outline and dimensions of all existing anJ • Indica[e North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing anG proposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inapection shall be made 24 Y�rs. in advance - phone 259-8810. <br />2. All work shall be performeu in accordance with this permit and curtent City ot Everett Design and Construction <br />Standards and Specificatiana <br />3. Call Location UndergroundSorvice 48 hrs. beforayou dig. TOLL FREE NUMBER 1•800-424•5555. <br />/�v�f `- �vm�.— /�'�ti°-za�,�s�`�� <br />� <br />//-8'�� <br />Approved tor Construction " � , Date <br />FINAL INSPECTION . Date <br />Approved as Constructed <br />�PUBLIC WCRKS DEPARTMENT <br />3200 Ceder Street <br />FvereM WA 98201 <br />� Phone:259-8810 <br />� <br />C <br />� <br />s <br />� <br />� <br />ACKNOWLEDGEMENTOFCONDITIONS � <br />The undersigned awner/applicant hereby agrees to hold and save harm <br />less the City of Everelt from any and all claims for damages, cost: <br />expenses, or causes ot action that may arise because of installatior <br />and maintenance o! the improvement or other rlght•of-way use heretc <br />applied tor and further agrees to remove same upan notice from the <br />City and to replace public property damaged thereby_:. �. - : _ <br />Signature of Applicant � � � � � Date <br />WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHII <br />180 DAYS OF DATE PERMIT IS ISSUED AND THERE:.FTER IS �TC <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY Bt <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI: <br />PROJECT OVEH 90 DAYS DURATION. � .� �� <br />