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Date 17—(,—Q1 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />iling <br />City <br />Put��.c Wo�Fs Perm�t • /�� -- ' <br />BI4V �?Pt � —�-ai'wlVd� � <br />Publm \Vo�ks iee g <br />To1al Fee <br />Less Pc01 Feo PaiO g <br />Oa�an-r Due� � <br />Phone <br />APPLICANT C��y Z�p Phone <br />qpplicant Mailing Address <br />Describe Proposed Work PLACEPIGNT OF OrFICE TRAILER <br />Project Address �it knownl 1712 W. PIARINE VIEW DR1V� <br />Atla�:h lour (4) copies of plans for proposed work - Draw lo scale and note � CQo11eWine ol slPee�cable: <br />• Property Lines • Indicate North <br />• Oulline and dimensions of all existin9 and � Show any proposed gradin9 changes <br />proposed struclures on lhe lot � Show measuremenls <br />• Existing and proposed utilities <br />nn NnT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />7. All cells for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and currenl City ol Everett Design and Consiruction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBE�+ 1-800'424-5 • <br />�. / � <br />/��,�_ctc_ �_u�^�/� �"?.i,,.,�.r ���` ���cc�,z..�' <br />`�h� <br />�2-� y/ <br />.1pP��ved for Cons��uction <br />FINAL WSPECTION <br />Aun����'�� �s Constructed <br />�� PUBLIC WORKS DEPAR?MENT <br />����"� 3200CedarSireet <br />��ltt�n Everelt. W� 98201 <br />Phone�259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />�♦h <br />V♦ <br />O <br />a <br />The undersigned ownerlapplicant hereby agrees to hcld and save harm� <br />Icss the City ol Everetl 7rom any and all Gaims tor damages, costs. <br />ezpenses, or causes of adio� lhat may arise because ef inslallation <br />and mainlenance of ihe improvement or other right-ohway use here�o <br />applied tor and further a9rees lo remove same upon nouce iwm thr. <br />ate City and to replace public properry damaged Ihereby. <br />Datc Date <br />Signature of Ap{�licant <br />80RDA STOFO DAT�E PERMI S ISEISSUED AND THEREA TER ISHTO <br />BE DILIGENTLY PURSUED TO COh1PLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI� <br />PROJ[CT OVER 90 DAYS DURATION. <br />