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Date�Y� <br />��- <br />Apphcalien For <br />PUBLIC WORKS PERM17 <br />Print or Type Only <br />Applicant <br />Atltlress <br />Adtlress <br />DescribeProposed�Vork � ��I , 1�•� <br />Prolect Address lil knownl <br />� <br />z�n <br />C�iy z�n <br />r��nn�: �v,�hs r,,, `- 7(�� _ ��� <br />tiin.� o�ni . ��(_T���-- <br />� <br />Publ�� WprAs 1 ru <br />10�TI �f0 `S <br />LesS A�ip� Fen Pniof S <br />e,i,���o�� s <br />�� iC� ,zc,G_kcr�t�i� �4�i� t._;��� <br />Aflach tour �4� cop�es ol plans lor proposr.d work - Draw to scale and nMe the lollowmg as apphcable: <br />• Property Lmes <br />• Outlme and dlmensions ol all ezisting and <br />prOPosetl StruClures on �he lot <br />• Existmg and proposed utihiies <br />• Center6ne ol s���eet <br />• Indiwte Nort:� <br />• Show any proposed grading changes <br />• Show measuremeMs <br />PERMIT CONDITIONS <br />1. All calls fo� inspection shall be made 24 hrs. in advance - phone 259•8910. <br />2. At� work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standerds and Suecilications. <br />3. Call Location Underground Service 48 hrs, betore you dig. TOLI FREE NUMBER 1•800•424-5S5S. <br />�. 1/�ND��7b� ^�-�LKIA.'% Ib(vS`T� f'�is �ICiIC1CD `�P> C—a3C4 �NL1C'�Yj �$ <br />�i-C.L �C/: E,�;` <Fl}r <br />�� � n�1��� 9 � r , �� <br />ApprovedTr Cons uction Date <br />� —�N—�� �—/�i'i�d <br />FIN4L INSPECTION Date <br />Approved as Consiructed <br />everctt PUBUC WORKS DE�'ARTMENT <br />� 3200 CedarStreet <br />Everett. WH 98201 <br />Phone�259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owneUappGcant herehy agrees te hold and save harm- <br />less ihe Cdy ol E-veietl irom any and all claims lor damayCs, costs. <br />expenses. or causes ol action that may arise because ol in�fallation <br />and mnmtenance ol ihe improvement or olher ric�hbol�way use hereto <br />applied lor and lurth�: a�rees lo remove same upon notice irom the <br />Cdy and to replace pubhc p�operty damaged ihereby. <br />c• <br />�v-/- <br />Signature ol ApPI can� —aa�e <br />WORK AUTHORIZED BY TIiIS PERAIIT MUST BE STARTED WIThIIN <br />180 DAVS OF DATE PERMII� IS ISSUED ANU THERE�FTER IS i0 <br />BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />C�NCELLED BV THE CITY UPON ANY STOPPi GE OF WORK ON THIS <br />PROJFCT OVER 90 DAYS DURATION. <br />