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.� <br />, <br />Date�3 TQ POSTING �/ I� PO����W��FaPe�mll�. 13�� <br />Application For eioa. oeo�. � <br />PUBLIC WORKS PERMIT PUEIicWoixsFee <br />Tolal Fee s J� <br />Lees �oo� iee va�a S <br />Print or 7ype Only Balanco0ue a� n � <br />Applicant <br />1330.1. �¢��S7S1= So..a�l�-... <br />noaress <br />Zip <br />� . /i7�i�l'SIM-f-r]7�lLdl��1rL:�l�Svi�L���L�iJI1 <br />_ • <br />Project Address (if known) <br />Attach four (4) copies oi plans tor proposed work • Dra6 <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposed slructures on ihe lol <br />• EaiS�ing and proposed u:ilitie5 <br />to scale and note ihe tollowing as applicaCle: <br />• Centerline ol streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />'�1 1. All cells for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City ol Everett Design and Construction <br />Standerds and Specificetiona <br />� 3. Call Locatton Undarground Service 48 hra betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />� �Q.W RT/tccF�d- ��vy^- <br />FINAL INSPEGTION <br />Approved as Constructed <br />PUBLI� WORKS DEPARTMENT <br />3200 Cedar Streel <br />Evere7t. wn 90201 <br />Phon��: 259�8810 <br />z- s-� <br />Date <br />9�.� � -y'� <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />♦�� <br />V♦ <br />O <br />a <br />The undersigned owner/applicant hereby aqrees to hold and save harm� <br />less Ihe City ol Everett Imm any and all claims for damages. costs, <br />expenses, or causes ol actio� Ihat may arise 6ecause of installation <br />and maintenance ol Ihe impro�ement or other righ4ol�way use hereto <br />applied lor and lurther agrees .o remove same upon notice from the <br />Cily and to replac uhlic propery damaged Ihereby. <br />,...�� '�� a s �y � <br />i nature ol Applicant � Date <br />WORK AUTHOR12ED BV T IS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY 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 />