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�r� <br />H <br />9H� <br />r <br />H � <br />tC C� <br />� M � <br />� <br />y �p � <br />�HGJ <br />OH <br />n <br />� � n <br />C"y� <br />Hy <br />8� <br />H <br />C]�W <br />�H�n <br />�� O Cn <br />Date�� <br />Applica�icn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />;h%"'j' <br />Put�i�c Worws Pnimn��•-�(r�� =/� <br />Biaq Oe01 • ti.J l. ��-vLJL� <br />Puni¢wortsnx —_—___— <br />lotN Fce 5 - <br />Le55ApYl iCe^a.� 5 <br />?L%�`��• <br />OdI�n:C:�uY 5 -- <br />Mailin9 <br />Descnbe Proposed Work <br />c�iv <br />Prolect Adtlress lil knowN � "� " ' `�-"`�—'— <br />. <br />Attach four l3) copies ol plans lor proPosad wo�k � Dnw lo swle and nofe ihe lollowmg 05 dPPGcable�. <br />• prope�ty Lines • Centedine ol street <br />• Outline and tlimensions ol ail existin9 i��A • Indicste Norlh <br />proposed shucture5 on ihe lot • Rhow any pwposeA 9�atling changes <br />• Existing and proposed utilities • Show measurements <br />��1 FERAIIT CONDITIONS <br />t. All calls for inspection shall be matle 24 hrs. in advance • phone 259-8810. <br />1' 2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br />� Standards and Specilications. <br />3. Call Location Undere�round Service 48 hrs. before you dig. TOLL FREE NUtdBER 1•800•424•5555. <br />' <br />' <br />� <br />I <br />/� <br />FINAtINSPEGTION- � <br />Approvetl as ConstructcA <br />evcrrtt PUBLIC WORKS DEPARTMENT <br />� 3200CedarSlreet <br />Everetl, WA 90201 <br />Phonc:259�8810 <br />11CNNOWL[DGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The under5igned ownedapplicant hereby agrees to hold and save harm� <br />less ihe Gty ol Everetl Irom any and all cl�ims lor tlama9es. costs. <br />eapenses, or causes ol action that may ari5e because ol installauon <br />and maiNenance ol Ihe improvement or other right�ol�way use hmeto <br />apph lor and lurlher agrees to remo�esame upon nolice Irom Ihe <br />City np to replace public pwpC�ty tlan fged thereby. �� � <br />�`� /C`�� � <br />ol <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAV BF <br />C.4NCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THiS <br />PROJECT OVER 90 DAYS DURATION. <br />