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r <br />IL <br />Date � 2 � y <br />Applicatio� For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />.cTN/C� �rLLri-iCl� �//%• �E <br />�wr Mailing Address <br />Prolect Address (if known) <br />� <br />Pablic Worke Permll • o y b U <br />eiao. oeo�. • � � <br />Public.VorkeFee '�j� p� <br />Tota� Fee S <br />Lena ApP� Fee Paitl S <br />P01anC: Jue S • � � — <br />Attach four (4) copies of plens for proposed work • Draw to scale and note the tollowinp �= applicahle: <br />J <br />• Property Lines • Centerline of street <br />� Outline and dfinenslons ot etl existing and � Show any pr� Posed grading changes <br />proposed structures on the lol � Show measurements <br />• Ezisting end proposed utilities <br />�� <br />����7 <br />P7C-3� <br />���s , �� . <br />Phony �/ _7� y / <br />(O J b <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hrs in advance • phone 259•8815. <br />2. All work shell be peAormed in accordance with lhis permit and current City of Everett Design and Construction <br />Stenderds and Specitications <br />3. Call Location Underground Service 48 hrs, trefore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�/T��— z-za-Sy <br />� Appro� tructlon Date <br />� � —Z —f3tl <br />FINAL INSPECTION Dat�- <br />Approved as Constructed <br />everett PUBLIC WORKS DEPART ENT <br />� 3200 Cedar Street <br />Everett, WA 90201 <br />Phone: 259•8815 <br />M <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ow��.er/applicant hereby agrees to hol;l and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because of instaltation <br />and maintenepce of th2 improvemenl or other right-o4way use hereto <br />applied for and turther agrees to remove' seme upon notice from the <br />Cily and to replace p�blic property damaged thereby. <br />,T/1 . . . . .. �iin �n . el � �b � � T <br />W RK AUTHORI2ED BY.THI$1Pl:AMIT MUST BE STARTED WITHIN <br />80 DAYS OF DATE- PERMI7 IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />� <br />