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Date�O—/ <br />ApPlicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�- � <br />Applicant <br />Describe Proposed Work <br />Pro�ect Adtlress (if known� <br />Mailing <br />C�ly <br />/" � Public WorAs P /f/ ���---���]]] j <br />I 01�9 De01 � �1 ��J- .- <br />7_in <br />Lp <br />Attach lour (4) copies ol plans lor proposed work - Jraw lo scale and nole ihe lollowing as applicable: <br />• Properry Lines <br />• Outline and dimensions of all existing and <br />proposed structwes on the lot <br />• Ezisting and propo5ed u�iGties <br />PutJiC YJO�k9 FCC <br />iOLll Frt� �u _ <br />L¢55 r.�01. Fn.e Pai� S_ <br />o,i,�,;� o�� 5 _ <br />• Centerline ol streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. AI! work shall be performed in accordance with this permit and current City of Everatl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />/ �C ��C=C-G �!/C- ZF���.— �7 i. i rLC ! �� �O %c �"C'� <br />�C/�_c c.�� <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Eveiett, WA 98201 <br />Phone:259-8810 <br />-;?j.; -����-�-r.� <br />� � -�-� � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />Iess Ihe City ol [ve�ett trom any and ali claims tor damac�es, cosis. <br />expenses, or causes of action that may arise becauae of installation <br />and mainlenance of the improvement or other righl-of�way use hereto <br />applied for and further agrees to remove same upon notice irom the <br />City and to replace pubGc proPerty damaged thereby. <br />Sic�nature ol Applican� Date <br />WORK AUTHORI2ED BY THIS P�RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSI�ED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br />CANCELLED BY THF CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />