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/_ _ <br />D�te�� <br />Applir,ation For <br />PUBLiC WORKS PERMIT <br />Print or Type Only <br />oina`oeoiF. �� /� ��_ .._. <br />� <br />PuGLc Wa�ks Fco <br />TOITI FeC S — � <br />1e55 Appl Fpe Pa�p 5 <br />2C. =� <br />eaianco o�m 5 _ <br />/ <br />Address <br />Describe ProposeG Work <br />Prolect AAtlress Iil known) <br />Gly eip rnune <br />Atlach lour (A) copies of plans lor proposed work - Draw to scale and note Ihe foltowing as applicabl=: <br />• Property Lines <br />• OuUine and d�mensions of all existing and <br />proposed sinictures on Ihe lot <br />• Exisling and proposed utilities <br />• Centedine ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show m�asuremenls <br />LI <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be p� ito�med in accordance with this permit and current City of Everett Design and Construction <br />Standards and Sozc.li�ations. <br />3. Call Localion Undergruund Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />5; �Ja�•�� ��� �5/5✓�0� �� L� �� � <br />�G �'rr�.,c� �� . .�`/�� C'c�:n.o�`u�c���J , <br />�S ��. s/.�� Q-�,4� n��� � �u� �m. <br />�i�a.�:., ��/o` sulQec ���i.oz- �z "cc��� <br />�v o ,� �/�� <br />".i �%O�G!/ �O i[O�z. .29 c 07.�'1C�...i p <br />� ���-f � z��� .� �' <br />//.:-.i.� Gs�c�'; ��-_ � _ <br />Approved lor Construction �� <br />; � ��'/', /�,,� - - <br />PINAL INSP[CTION � ��� �� � <br />Approved as ;ons'�uc d <br />evemtt PUBUCWORKSDEPARTMENT <br />� 3200CedarStieet <br />[verett, WA 9b201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned ownerian�licant hereby a9rees to hold and save harm- <br />less �hc City ot Everett irom any and all claims for dama9es, cosis. <br />e■penses, or causes of action that may arise because of installation <br />and mainlenance ol Ihe improvemenl or other ri�h�-ot�way use hereto <br />applied lor and further agrees �o remove same upon notice from the <br />Ciry and lo replace pu6lic property damaged thereby. <br />/ Signature ol Applicant """ <br />WORK AUTHORIZED BY THIS PERAIIT MUST BE STARTED 6VITHIN <br />180 DAYS OF DATE PERMITIS ISSUED AND THEREAFT[R i5 70 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PER�AIT MAY DE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNiS <br />PROJECT OVER 90 DAYS DURATION. <br />