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��]� �� <br />De1C__���} " <br />qppliGation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�;� <br />T=�,a�S ����= 3�-1 <br />Owner <br />Mailing Atldres �, City <br />Ciry <br />Describo Proposed Work <br />r�o��c wo�w. Pe�m��� ` //�j— <br />BIEp. DeD�� • � � <br />pubbc Wo��� Fee s —_ <br />Tol�l Pee <br />Le�s �oD� Fee Pe�O S—�-- <br />Ba���ce Oue s —�— <br />, i 9��aY �3� s ���: <br />Z�p Phone <br />Z�p Phone <br />/ � v ' —( � l 4 / . �— <br />Project Address P� known) -- �� <br />Altach lour (4) copies of plans lor proposed work � Draw 10 scale and note the tollowing as applicaUle�. <br />• Properry Lines <br />• Oulline and dimensions ol all existing and <br />pioDosed slrucWres on the lot <br />• ExiSting and p�OpoSed u�ilities <br />• Centerline of strect <br />• Indicate Norlh <br />• Show any proposeA 9�atl�ng chanc�es <br />• Show measurements <br />PERMil CONDITIONS <br />1. All calls br inspecPon shall be made 24 hrs. in advance � Phone 259'881 5. . <br />2. All wcrk shall be pedormed in accordance with this permit and wrrenl Cily of Everett Des�9n and Construction <br />Standards end Specilications <br />3. C311 location Underground Service AB hrs. 6elore you dig. TOIL FREE NIIMBER 1•800-424•555 . <br />� �C � <br />u <br />�;J <br />bl�� ,� <br />l �" i�'✓"� <br />Date <br />ApprOved for Consiruction <br />Date <br />FINAL INSPECTION <br />Approved as Construcletl <br />0 evcrett PURLIC WORKS DEPAf+�: MENT <br />J200 Cedar Street <br />Everett, WA 98207 <br />� Fhonc:259-8815 <br />� <br />,�i'. � <br />r �� ' <br />� a /�� <br />,%• v <br />, �-� <br />� <br />� <br />AGKNOWLEDGEMENT OF CONDI110N5 <br />The undersignetl owner/applicant hereby agrees lo hold and save harm� <br />less �he City o1 Everetl irom any and all Gaims lor damages, costs. <br />expenses, or causes of action ihat may arise because oi installahun <br />and mamtenance ol ihe improvement or other righ4obway use hc:�i� <br />aF.r4ed Icr and lurther agrees lo remove same upon notice hom the <br />City and to rep�ace public property damaged Ihereby. <br />Date <br />Signature ol APPlicant <br />BORDAYS OFRDATE P[RMIT ISEI�'�SUED ANO THEREAFfER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANV STOPPAGE Of WORK ON Tfi�s <br />PROJ� CT OVEF 50 UAYS DURAiION. <br />