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J�/ <br />Date� y' <br />Application For <br />PUBLIC VI/ClRKS PERMIT <br />Print or Type Only <br />City <br />�r+� <br />Applicant Mailing Address City Zip <br />Describe Proposed Work <br />Praject Hddress (if known) <br />Attach lour (4) copirs of plans for proposed wor:c - Draw to scale and note the lollowino as applicable: <br />• Property Lines <br />• Ou�line and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />PuGbc Wo.ke; Permi� n <br />e�de. oeot. r i�'. �n � / %�lg� <br />�__"�'_ <br />PublicWoiksFea g <br />Tmal Fae <br />LesS ApP�� Fee Paid � <br />�aianceDue 5 <br />� o�J o� —YJ 7 7' <br />Phone <br />• Centerline of sireet <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />1. All calls for inspection shall be made 24 hrs. in advance - �hene 259•881 5. <br />2. All work shall be perforroed in accordance with this permit and wrrant City ot Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500-424•5555. <br />�� ������ <br />/ <br />�/ �C-����U%�'r,� <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett WA 38207 <br />Phone:259-8�15 <br />D�te <br />U//•S/8� <br />v �„ <br />c.� �;�� ,� % <br />�._. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />�� <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the Ciry of Everett Irom any and all claims tor damages, cos�s, <br />expenses, or causes of action thaf may arise because of installation <br />and maintenance of �he improvement or olher righboFway use hereto <br />applied for and furiher ac�rees to remove samr. upon notice from the <br />City and to replace public properry dama9ed �hereby. <br />Signature of Applicant �ate <br />WORK AUTHORIZED BY TH�S PERMIT k'JST BE. STARTED WITHIN <br />1 JO DAYS OF DATE PERMI'� IS ISSUED AND T� IEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. iHl9 PERMIT MAY BE <br />CF,NCEL�EG BY THE CITY UPON �NY STOPPAGE ���F WORK ON THIS <br />PFOJECT OVER �0 DAVS DURATION. <br />