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Date _ <br />ApPlicaiion Fcr <br />�178LIC iNORKS PERIVVIT <br />Print or iype Only <br />Haa�ess <br />Describe Proposed Work <br />i <br />Pi�bliL WOfhS V�'Imi� %%% <br />{31�1�� UCO�. f �(�.,3��_ <br />PuUlin Wo�hs Fe9 / <br />.����F�o s <br />�essaooi.Fceaa��a $. <br />e�i��o� o�e 5 <br />Sc <br />City Zip <br />�' � _...��,�-�n../ <br />Proj_ct Address �if known� �� .�,E ,���J�QL� <br />Attach fnw (4) copies of plans for proposed •,vork - Draw to scale and noie the following as applicable: <br />• Property Lines • Centedine of street <br />•(lutline and dimensions of all existing and • Intlicale ;Jorih <br />proposed structures on the lot • Show any proposed gradinc� changes <br />• Existing and prouosed utilities • Show measuremenis <br />PE(tA11T CONGITIONS <br />'. All calls for inspection sLall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in acr,nrdance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Untlerground Senrice 48 hrs. before you dig. TOLL FREE NUMBEH 1•800-42Q•5555. <br />/�/�-ta ,�� � <br />��i —Z 3-88 <br />Apprcved for Construc�ion <br />FINAL INSPECT�ON Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98207 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />a <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims br dama9es, cosfs. <br />expenses, or causes ol action that may arise because of installation <br />and maintenance of the improvement or other righl-cf-way use hereto <br />applied lor and furiher agrees to remove same unon notice trom ihe <br />City and to replace pu6lic piopeity damaged Ihereby. <br />Signature ol ApPlicant � Date <br />WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAMCcLLED BY THE CITY UPON ANY STOPPAGE OF WOqK ON THIS <br />PRJJEC7 OVER 90 DAYS DURATION. <br />