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Date�'S Iv <br />Applicatlon For <br />PfJBL�C V�/ORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Prop�sed Work <br />Project Atldress (if known) <br />❑g Address <br />Mailiny <br />PUULc lVo�ks Permil s <br />eioe. o�oi. , —__,y�i_�J>��� <br />PuC��c Works fee <br />Tolal Fee $ <br />LesS Acol Fea Paid $ <br />Baianr.o Jue S <br />�_as�-�ss9 <br />Phone <br />'or� %203 �S3- �� <br />Z�P Phone <br />A;tach four (4) copies of plans for proposed viorl: - Draw to scale aad note the lollowing as applicable: <br />• Property Lioes <br />• Outline and dimeusions of all existing and <br />proposed strucl��res on ihe 7ot <br />• Existing antl proposed utilities <br />PERMIT CONDITIONS <br />• Cente�line of street <br />• Indicate Norih <br />• Show any proposed gratling changes <br />• Show measurements <br />1. ?.II calls lor inspection shall be made 24 h�s. in advance � phone 259•881 5. <br />Z. All work shall be perlormed in accordance with this permit and current City ol Everett Design antl Consiruction <br />Standards and Speci�ications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER �-800••424•5555. <br />f �L� /�c�:��rir % .(�OT �'�G'C'�.�'c`O <br />,' <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Cor.structed <br />everelt PUBLIC WI�RKS DEFARTMENT <br />� 3200 Cedar St�eet <br />Everett. WA 98207 <br />Phone: 259-8815 <br />i <br />g ' � 96 <br />�� <br />;��. �, <br />�_,;��� , <br />. _...-�. . ::-L� <br />/ , <br />ACY,NOWLEDGEMENT OF CONDITIONS <br />LtJ <br />� <br />�w <br />� / <br />r <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ol Everett ;:om any and all claims lor damages. co;ts. <br />expenses, or causes ot action that m2y arise because ol installation <br />and maintenance ol the improvement or o�her righPobway use hereto <br />applied tor and furthrr agrees to remove same upon notice from the <br />City and to replace public proGerry damaged ihereby. <br />Signature of Applicant Date <br />WORK Al1THORIZE-D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COPdPLET;JN. TH�S PERM11IT M11AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRnJECT OVER 90 DAYS DURATION. <br />