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Date��� <br />Application For <br />PU1BL1� WORKS PERMIT <br />Prir�t or Type Only <br />Owner <br />Mailing <br />Describe Propos=d Work <br />Project .cddress (if known) <br />lk <br />City <br />ZiP <br />Zip <br />Publlc WorkS Pc�ml� c <br />81EB. DePt. x �Iz6_�_—_- <br />Puelic works Fco <br />Toia Fea S <br />less ApO� Fce Paitl S -- <br />Balen:e Oue <br />Attach four (4) copi; �.. of piuns for proposed work • Draw tu sc, le and note the lollowing as applicable: <br />• Propciq� Lines • Centerline o! street <br />b Oc�linc :�nu dimensions ol all existing and 6 Indicate North <br />propcse� structures on the lot • Show any proposed gradinc,7 changes <br />Y Existing and proposed utilities • Show measuremenis <br />PERMIT CUNDITIONS <br />Z�%�—%/)2/ <br />Phone —T <br />3� y -�is�- <br />Ail calis lor inspection shall be madr 24 h�s. in advance - phone 259•881 5. <br />All work shall be performed in accordance with ihis permi� and current Ciry of Evere�[ Design and Consiruction <br />Sizudards and Specifications. <br />Call Lucation Underground Service 48 hrs. before ycu dig. TOLL FREE NUMBEP. 1•1i00•424•5555. <br />�� :�> c /G Lc�G��,t.S �� �/ni% / ��� l'jEni Cii �Y_� <br />Approved for i,onstruction <br />FINAL. INSPECTION <br />Appro��ed as Construcled <br />everett PUELIC WORKS DEPARTMEIJT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />�.J�LC � cJn! <br />. L!_`/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />Inss the City of Everelt from any an�i all claims (ur damages, cosls, <br />erpenses, or causes of action �hat may arise becausa of installalion <br />and maintenance of tha improvement cr other right-ol-way use hereto <br />applied for and further agrees to remove same upon nolice from the <br />City and to replace public property damaged ihereby. <br />Date I <br />Signature of Applicant Date <br />WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />t80 UAYS OF DATE PERMIT IS ISSUED F.ND THEREAFTFI7 IS TO <br />BE LILIGERTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEU BYTHF CITY UPON ANY CTOAPAGE OF l^lORK ON THIS <br />PROJECT OVER 90 �AYS DURA'ION. <br />