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) <br />Date � <br />qpplicaticn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />C�.1'IiC.\YO'FS I�pin�i����. .. <br />61n9 Deol ' .� -_--_-. <br />PunLCWo��xfce S <br />tob�i Fer - - <br />Less Apol Fen Pa�.n $ — <br />eai.,,��� o�� <br />V W IICI <br />Applicanl <br />Mailing Address <br />G1�Y ZI� <br />Describe Proposed Work _ � 1��� `� I/ `` I� v�� � <br />Proled Address hf known) <br />Attach four 141 copies ol plans for proposed work � Draw to scale <br />• Properry Lines <br />• Oulline and dimensions ol all existing and <br />proposetl structures on the lol <br />• Existing and proPosed ulihhes <br />ihe lollowing as apPlicable: <br />• Genterline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current Ciry ot Everett Design and Construction <br />Standards and Specifiwtions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />Approved inr Consiruction <br />FINAL INSPECTION <br />Approved as Conslructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259�8810 <br />' (n� ���� <br />L <br />,����� <br />��� �R� <br />�CKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />r <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The unders�gneA owner/applicant hereby agrees to hold and save ham�- <br />--- tess the Gty ol Everelt Irom r ny and all claims lor damages, costo <br />e�penses. or causes ol action Ihat may arise because ol installa�ion <br />and mamtenance of lhe improvement or other right-obway use hereto <br />applled tor and furiher agrees to remove same upon notice Irom the <br />D3�� G;ty and to replace pubfic property damaged thereby. <br />Signalure ol Applicant """ <br />WOf?K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER iS TO <br />8E DILIGENTLY PURSUED TO COI�APLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOFPAGE OF WORK ON THIS <br />PROJECT OV[R 90 �AVS DURATIGN. <br />