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� <br />� <br />Date���� <br />ApG�icalion For <br />RUBLIC WORKS PER11AlT <br />Print or "ype Only <br />��dw� l l �,tld,t 1`!00 S <br />Mailing Address <br />C. .�/Gi7 —��.-2�/il�. � <br />Describe Proposed Work �ef�A.t� 1 --l— �7�T <br />Project Atldress (il known) <br />M <br />Zip <br />Zip <br />Attach lour (4) copies ol plans lor proposed work - Draw to scale and note the lollowing as epplicable: <br />� Property Linee <br />! Outline and dimensions of all ezistinq and <br />proposeC structures on ihe lol <br />• Existing and proposetl utililies <br />PERMIT CONDITIONS <br />Pvp�icWa�MfPorml�+ �� ��`/ � <br />2108. DeOt r � ,.1_� i _ <br />PUEIic Works Fee 7�7� OD <br />Toiai Fce 5 <br />LessADPI. Fee PeIC � <br />Balenca Oue $ , �• U O <br />o Centerline of street <br />�l Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />7. All calls for inspection shail be made 24 hrs. in ad:•anr,e - phone 259•881 5. <br />2. nll work shall be performed in accordance with ihis permit and current City ot [verett Design anJ Construclion <br />Star.dards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. YOLL FREE NUMBER 1-F300•424-5555. <br />��"Z S �� f/ <br />Approv� orL'onstruclion Date <br />�//� r���.�-- /-/%- �d� <br />FI L INSPECTION Uate <br />Approved as Construded <br />everel PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Eveiett, WA 98201 <br />Fhore: 259-887 5 <br />AGKNOWLEDGEMENT OF CONDITIONS <br />., <br />�� -,��- <br />�ol� l�nJ <br />� <br />N <br />O <br />� <br />The undersigned owner/applicanl hereby agrees to hold and save harm� <br />less �he City ol Everett from any and all claims for tlamages, costs, <br />expenses, or causes of action �hat may arise because of installalion <br />and maintenance of ihe improvement or other right-of-way use hereto <br />applied for and further agrees to remo+e same upon notica irom ihe <br />City and to replace public property damaged ihereby. <br />SignaWre of ApPlicant Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />780 D�YS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />BE DILIGENTLY PURSUED'f0 COMPLEIiON. THIS PERMIT MAY BE <br />ChNCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />� <br />