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Dete��O"8� <br />A{�plication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Meiling <br />Meiling <br />Zip <br />[ip <br />Pu�l�¢ Wo�ks Pe�mil • �� _G � ` <br />eiaa oeoi.• <br />P�b�,�Wo,.�F�a s <br />Tolnl F.e <br />Lese ApO�� Fea Peltl S <br />7LIO�CB �U ��S �O � �"..��L�'� <br />/� �� / <br />R�,ein.T '� J(o ^2 Z 2 <br />�. �.cCf•.� �a�o. �.�a�a�u��.� �� __ _ _ ____ __' <br />��i <br />t 7' ► <br />�ro;�ct Address fil known) — <br />Attar.h, four (4) copies of plans for proposed work • Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outlino and dimensions of all existing and <br />proposed structures an the lol <br />• Existing and propased utilities <br />• Cenler�ine ol slreet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONCIT�OYS <br />1. All calls lor io�;�ection shaii :� made 24 hrs in advance - phone 259-88i 5 <br />2. All work sha�.l be pe�o�med i�i accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificatio��s. <br />3. Call Locatiun Undeig�ound Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />O�t' f2-� OE•wocs <br />����o� 6� 8� <br />Approved for Co ruction Date <br />�-%��w� �-r-�� <br />TNAL INSPECTION Date <br />Approved 25 Constructed <br />everet[ PUBLIC WORY.S DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•U915 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigoed ownedapplicant hereb�� agrees to hold and save harm• <br />less the City of Everett from any and all claims for damages. costs, <br />expenses, or causes of action that may arise hecause of installation <br />and maintenance ol the improvemcnt or other righ4ohway use hereto <br />applied for and lurther agrees to remove same upon notice irom the <br />City and Sq replace public propgrty damaged ihereby. <br />3 <br />d <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED \NITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAN�ELLED 9Y THE CITY UPON ANY STOPPAGE OF WORK ON TFIIS <br />PROJECT OVER 90 DAYS DURATION. <br />