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Dete�/ - -� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� ZOyL� .N <br />Mailing Addross <br />DescNbe Propoaed Wurk <br />Projnr.t Addreas (il known� <br />���Y <br />PuOM1c Wo�F� Pe mlt • '�" �- J'� � <br />pltla Unn1. � _�� / � �� / <br />PuelicWurbfrn s <br />Tolei Fao <br />Leae �ppl fea Aa�iA S `�- <br />Ualence Dua i _ <br />Phona <br />Gily Zlp Ynono <br />AttacL• tour (4) copies of pians Im proposed work • Draw lo <ca�e and note the following as opplicable: <br />• Property Lfnes <br />• Outline and dimenaions ol all exisling and <br />proposr,d structures on Ihe lot <br />• Existing and proposed utilities <br />PEPA7�'; CONDITIONS <br />• Centeillnc ol street <br />• Ind�cate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />��'-S3i <br />1. All GPIIS lOr insp�CtiOn Shell be maAe 24 hrs. in advenGe � phOnc 2S9$8� 5. <br />2 All work shall bo perlormed in accordanCe with Ihis permi� and current City ol Everett Design antl Construcllon <br />Sta.�dords and Specificat�ons. <br />3. Call LxaM1ort Uno�,:ground Service 49 hrs be�ore yeu dig. TOLL FREE NUMBER 1-800•424•5555. <br />Q.ticc�.•e.� fO.,i.✓6 .GY�/ /_'FG.'�c�cc!Cl <br />�Z <br />Approvedlor <br />FINAL INSPEGTION � <br />Approved as Construclod <br />everett PUBL�" �NORKS DEPARTtdENT <br />� 3200 G iar Street <br />Everett. �. 4 98207 <br />Phone:25�_ BB15 <br />tc <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersignr.d own^riapphcanl hereby agrees lo ho10 and save harm• <br />less the City d Everett Irom any ar,d all claims lor damages. costs. <br />expenses, or causes of action Ihal may arise because of installation <br />and maintenance ot the Improvement or olher right•ol-way use hereto <br />applied r and lurther agrees �o remove same upon notice Irom Me <br />City an o replace p bti property damaged thereby. <br />' � ' �� <br />Sig al�irc of Appli ant Date <br />VlORK AUTHORIZED BY THIS PERMIT blUST BE 3TPRTED WITHIN <br />180 DA1S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PFRMIT MAY ElE <br />CANCELLEU BY THE CITY UPON ANY STOPPAGE OF WONK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />