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� .�`-: <br />° �f ^•'T `x' <br />_ i< <br />+`, <br />� `. f"''�� . . <br />Date�lc}C1 <br />Application For <br />PU�LIC 1NORKS PER�IT <br />Print or Type Only <br />Mailing Address <br />Pu�l¢ Works Permil a v� ���� <br />91�J. OePt i �Q'�� t'O.. — _ <br />PuEbc WaiFs Feo <br />TotN Fne 5 — <br />less Appl. Fee PaiO $ � �-- <br />eaiance ouc 5 =� _ <br />.�,.�,� s ��as�e- �s3 a�z� <br />Gty Zip Phonc <br />1 Q <br />App icant Mailing Address C�ty Zip Phone <br />Describe Proposed Work ��-1F <br />/J <br />Prolect Address Iil known) � � � ���^�^ � '� •�' `-' <br />Attach four (4) copies ot plar.s for proposed work - Draw to scale and note Ihe lollowing ss apulicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the bt <br />� Exic;ing and proposed utilities <br />• Cenlerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PE'RMIT GONDITIONS <br />1. Ail calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />i n � <br />� fiL � .:YllTo'1'-�-� 7 /%/'��— <br />Approved for onstructi n Date <br />G�'�.�— /O-d Y-d�% <br />FINAI INSPECT�ON -7Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Stre^t <br />Everelt, WA 99201 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />�w <br />�/ <br />O <br />a <br />The undersigned owner/applicaM hereby agrees to huld and save hann- <br />less ihe Cily of Everett irom any and all claims tor Aamages. costs. <br />expenses, or causes of action ihat may arise because of installation <br />and mai�tenance of the improvement or other right-of-way use herelo <br />applied lor and further agrees to remove same upon notice from the <br />City and to replace pu6lic property damaged thereby. <br />���'�''��.� �� 7� �i <br />a ure of 4pplicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS 01= DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />C�INCELLED E�Y THF. CITY UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJECT OVER 90 DAYS DURATION. <br />