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Date��9' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or'lype Only <br />14. <br />C,�(� p f� <br />Pu04c Works Pcrm.t • C_/ -/� �—, n/�J <br />Biag ocoi., ��9?�[lLfl�_ <br />ruoi�c wo�Ms rre s <br />Toi.11 Fea <br />Le55l�ppl Fee PaiU S <br />> cn <br />e.,i,,,,; � o„�. S ' C— <br />Sn rt�!_ <br />Applicant Mailing Address City Lp Phone <br />Describe ProposeA Work <br />Project Address (il known) <br />Attach f0uf 14) Copie� Of plan5lor pfoposed work - OfaW to SCale and note Ihe lollowing as apPlica6le: <br />• Property Lines <br />• Outline and dimen5ions of all existing and <br />propo5ed siructures on ihe lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any propo5ed gratling changes <br />� Show measurements <br />PERMIT CONDITIONS <br />7. All calis for inspectlon shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in accordance with this perTit and current City ot Everett Design and Construction <br />Standards and Specificationa <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•80�-424•5555. <br />j� i, � - / -,[� ��� <br />/i �eCc�� /�c`�=�-��%/,�•l.lG "..���1LCi.v•;-?�� , <br />v � <br />�1��/ / `7lf"/f3��iez�^— .S 5� -�5'� <br />Approve r onstruction Da�e <br />����� �/s�� <br />FINAL INSPECTION � Date <br />ApproveA as Constructed <br />everett PUBUC WORKS OEPAR7MENT <br />� 3200 Cetlar Street <br />Eveielf. WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/applicant hereby ayrees to hold and save harm- <br />less the Gly ol Everelt Irom any and all claims for damages. costs. <br />ezpenses, or causes ol action that may arise because of installation <br />and maintenance ol the improvemenl or olher right-of•way use hereto <br />applied for and Iwther a ees t remove same upon notice from the <br />City,.Kfd%o place bl op damaged thereby. <br />� <br />�ig a� - ol pp Ica/ � at <br />WORK PUTHORIZED BY THIS PEFM�T MUST BE STARTED WITHIN <br />180 DAY3 OF DATE PERMIT IS ISSUED AND THEREAFiER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE Cll'Y UPON ANY STOPPAGe OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />