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Date �'�—��",�' <br />.4pplica'ion For <br />Pt�BLIC WORKS PEI�MiT <br />Print or Type Only <br />Owner <br />Mailing <br />Cily <br />ru[J¢ waM1s perm.t . <br />e�av o�ni . .F.F � �_? � �13 % __ <br />VUMic Worxs Feo <br />Totel Fee $ <br />I.essAoO�-FeeGaiO $ <br />e,c,��� o�� a <br />1111Tr,r'1 J.�1� _I(alld- �tiA✓P_fF Sna�in�rli�riti /�R'.�9�� y b-.�isb _ — <br />Ap{,litant Mailing Address City Zip Phone <br />Descri�eProPosedWork TPNGN_I- IM�/l�f�/P�4N� r/iIGMnDn��Iis� Ll�f-p —���%,� 7��rC/— _ <br />Project .4ddress (il known) <br />Adsch four �4) copies of plans for proposed work • Draw to scale and note �he followiny as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed strucW r:s on the lot <br />• Existiny and proposed utilities <br />Cenlerline of sVeet <br />Indicate Norlh <br />Show any proposed grading chan9es <br />Show measu�ements <br />PERMIT CONDITIONS <br />1. All calls for inspec!'on shall be made 2h hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City ot Everett Design and C:onsiruction <br />Stendards and Specifications. <br />3. Call Location Underground Service 48 hrs. before ��ou dig. TOLL FREE NUMBER 1-800•424•5555. <br />iUOT iP€q. «�� 5�/if/8� <br />Approved tor Co iatruc!�on Date <br />FINAL INSPECTION <br />Approved as Constrar.ted <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 C[ dar Sireet <br />Everett. WA 90201 <br />Phone: 259-8870 <br />ACKNOWL[DGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The unde�signed owner/applicanl hereby agrees to hold and save harm� <br />less the City of Everett Irom any and all claims lor dameges, cosls, <br />exGenses, or causes of aclion that may arise because of installation <br />and mainleoance of lhe improvement or olher ri�ht�ol-way use herelo <br />applied for and lurlher agrees to remove same upon noti[e from the <br />City and to replace public property damaged thereby. <br />Signa�ure of Applicant Date <br />WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEf±MIT IS ISSUED AND THEREAFTER IS TU <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 9Y TfiE CITY UPON ANY STOPPAGE OF WORK JN THIS <br />PROJECT OVER 90 DAYS DURATION. <br />