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Date ( G /'7� <br />Applica�ion For <br />PU�3LIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />DesCnbe Proposed WOrk <br />Project Address �i� knownl <br />Cily <br />City <br />Zip <br />z�� <br />Attach fow (4) copies of plans for proposed wo�k - Draw to scale and note ihe lollowing as applicable: <br />• Prope�ty Lines <br />• Outline and dimensions ol all existinq and <br />proposed structures on Ihe lot <br />• Existing and proposed utilities <br />Pullhf �yprFS P^� ♦ � <br />91np Den� • .�/[�� _ <br />P�pl¢Wa�IxGee ----' <br />iolql FCC S _�_ <br />LessdnplFenPnips _ <br />en�ann. ouc s <br />• Centerline of street <br />• �ndicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All cails for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standartls and Specifications. <br />3. Call Location Unde•ground Service 48 hrs. before you dig. TOLI FREE NUMBER 1•800•424-5555. <br />���- .��. <br />,. /� / <br />( l--I�GG lG�'zf':' �_CZ.^>�1 � ( .'�?`� ��P�• <br />� <br />' ,�: G � .-/� <br />� -��- -,;�i <br />lor Construdion <br />ACKNOWLED(i[MENT OF CONDITIONS <br />The undersigned oaner/applicant he�eUy agrees to holtl and save harm� <br />less Ihe City ol Everett Irom any and all claims for damages, costs. <br />eapen5es. or Causes ol action Ihai may anse beCause ol inslallatlon <br />and maintenance ol Ihe improvement or olher righbobway use hereto <br />applied fo� and iwther aqrees to rernove same upon notice �rom the <br />Date City and to ieplace pubhc property dama9ed Ihereby. <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 99201 <br />Phone: 259•8810 <br />ture of ApUlicant <br />Date <br />WORK AUTHOFIZEG BY THIS PERMIT MUST BE STARTED WIiHIN <br />180 DAYS OF DATE PERh11T IS ISSUED AND THEREAFTER I�5 TO <br />BE DILIG[NiL1' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />