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�, <br />Date�'! <br />� <br />� <br />App�ica�ion For <br />PUBLIC W�RKS PERMIT <br />Print or Type Only <br />Mailing Atldress <br />Mamng Aaoress <br />Describe Proposed Work _f]�A.L�(� CQ/�G Q- <br />Project Address �il known) <br />� <br />Pub�ic Warhs Pcrmit a <br />0��9 Deot.. �� �� — - <br />�_" <br />ruel¢ wa�s rcc ! <br />10�TI FPP `� — <br />tess nnn� �ee Pn�a S — <br />Baianco ouo S <br />'—✓0/'0/7' Z�ZD� c�sa—�'oZS�1— <br />C�ty LP Phone <br />Citv ZiP Phone <br />Atlach fow �4) copies of plans lor proposr.d work • Draw fo scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all ezisting and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show m2asurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shell be made 24 hrs. in advance • phone 259-8810. <br />2. All wark shall be performed in accordance with this permit end current City of Everett Design and Construction <br />Standerds end Specifications. <br />3. Call Locetion Underground Service 48 hrs. before you dig. T04L FREE NUMBER 1-800-424•5555. <br />/ , ,/ ../ � <br />� �C� /�CG-C' CC'L'':'/.�� /.c.=>-IJLC! 'L�(� L' L'2�[�� <br />� <br />'- .l�/. %L'�'�'� <br />y��8y <br />Approved for Gonsiruction Date <br />FINAL INSPECTION <br />Approved as Construcled <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Cetlar Street <br />Everett, WA 9A201 <br />Phone:259-BB10 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicait hereby agrees to hold and save harm- <br />less Ihe City of Everetl Irom any anA all claims tor damages, costs. <br />e■nznses, or causes of action Ihat may arise because of installation <br />and maintenance ol the improvement or other right�o4way use hereto <br />. pplied lor and further agrees to remove same upon notice f�om the <br />Gity and lo replace public property damaged thereby. <br />Signalure ol ApPlicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi 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 />