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Date��1 �� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��,������ �v�,�,. ���,".��,,, � ) <br />mau n�ni • ' > i ��� ` _ <br />Puel¢ worMe Fno s <br />.m�i r�o <br />i�:s noui. Fe� rn�d 5 <br />ealnnc� Juo 5 <br />�� �,r�� � ��� � <br />Describe Proposed Work ��i—LL�� , . <br />�''� <br />PrOjecl Addresslif known) �i�.�� . <br />Attach fou� (4) copies ol plans lor proposed wcrk 0•aw to scale and note lhe lollowing as applicable: <br />� Property Lines <br />� OuUine and dimensions ol all existing a��1 <br />propoaed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline o( street <br />• Indicate North <br />• Show any proposed grading chanc�es <br />• Show measurements <br />t. All calls for inspection shall 6e made 24 hrs. i�i ad�ance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards end Sperilications. <br />3. Call Location Underground Service 48 hrs. betorc vou dig. TOLL FREE NUMBER 1-800•424•5555. <br />�UBG/C C�J��,�;LS� �(10l �P�rC•�,�ip <br />Ao�roved for Conslruction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sirecl <br />Everett. W� 9A201 <br />f�hnn?: 259�d01 5 <br />ACKNOVJLEDG[MENT OF CONDITIONS <br />W <br />� <br />� <br />r <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe Cily of Everetl irom any and all claims for damages, costs, <br />expenses, or causes ol ac�tion that may arise Secause of inslallation <br />and maintenance ol the improvement or other right-of�way use hereto <br />applir.d lor and lurther agrees to remove same upon notice Irom lhe <br />Datc rity and lo repla e pubiic proPer�y damaged thereby. <br />Signaturn of �pplicanl Date <br />WORK �UTHORIZED BY THIS PEFMIT MUST BE STAP.TED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEf'. IS TO <br />BE DILIGENTLY PURSUF.D TO COMPLETION. THIS pEFM1T MAY BE <br />CANCf_LLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVC�: ;�� vi1+J UURATION. <br />