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Date��'F��' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />'Lip <br />M211Ip9 A�(11BSS <br />Desc•ibe Pioposed Work <br />Prolect Address (if known) 3��� �— <br />Attach lour �4) copies ol plans lor proposed work - Draw Io scale and note ihe lollowing as applicahle: <br />• Properry Lines <br />• Outline anA dimensions of all exisling and <br />proposed slructures on the lot <br />• Existing and propo5ed ufililies <br />Pu�LCYlatksPc�m.1+ �"' ^ ��� <br />ein�� oeoi • � <br />Puel¢wo�Msice s <br />TOIPI Feo <br />lCs, nnol i Pe Pam S_%� <br />011.lncrDuP S "'Q _ <br />• Centerline of street <br />• Indicate Flor�h <br />• Show any proposed grading chan�es <br />• Sho�.v m�asuremen�s <br />� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall he made 24 hr;. in advance - phone 259•L'810. <br />2. AII work shall be performed in accordance with this permit and cvrent City of Everett Desi9n and Construction <br />Stardards and Specifications. <br />3. Call Location Undeiground Service 48 hrs. before you dig. TO�L FREE NUMBER 1-800•424•5555. <br />� <br />��'��i � <br />f/I.� �ivz��- ///2 <br />Apnroved for Cons�r�tion' ' / ate <br />c � <br />�'��-� ��3 Ji <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everMt PUBLICWORVCSDEPARTMENT <br />� 3200 Cetlar Street <br />Everell. WA 38201 <br />Phonc:259�8810 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owneVapplicant hereUy a9�c�s to hold antl save harm� <br />less the City ot EvereU Irom any and all clams br damages. costs. <br />ezpenses. or causes ot action thot m. y arise because ot installation <br />and maintenance ol 'he Improvemenl or other rlghPol-way use hereto <br />applied �or and lurth�•r a9rees lo remove same upon notice Irom the <br />City and lo replace p�blic property dama9ed Ihereby. <br />Si9natwe ol Ap icant �_� � Datc <br />WORK AUTHORI2ED BY THIS PERMIT A1UST BE STARTED WITHIN <br />180 DAVS OF DATF PERMIT IS ISSUED AND THERE�FTER IS TO <br />EIE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT IdAY F3F: <br />CANCELLED BY THE CITY i��f1N ANY STOPPAGE OF 1NORK ON THIS <br />PROJECT OVER 90 DAYS DURA1 �ON. <br />