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Date <br />Applicetion For <br />PUBLIC WORK.S PE'RMIT <br />Print or Type Only <br />LGLYY� �' Cr 11i Y1 <br />L-� L . �+ <br />uwoer <br />Address <br />�iT" <br />ST <br />v�eie won. w�mn • g5 � <br />BIOp. D�pl • <br />a�eik wom. �» ' <br />To1N F�s <br />Lau �OP� Fb PaM : p <br />B�I�ne�Dua i L�•QO <br />!�' <br />Ciry uP rnOne <br />Describe P�oPosed Work 1 C, ��l 1( I i1 y�JU � t�Ui�'l F. [`'� ��J-Pc� , <br />Pro�ect Addreas (it known) <br />Attech four (4) copies of plens for proposad work • Draw to scaie and note lhe fol�owing as applicable: <br />• Property Lines • Centerline ot street <br />� Outline end dimensions of all existing and • Indicate North <br />propos,d s!ructures on the lot � • Show any proposed grading changes <br />• Existinq F�nd proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs in advance • phone 259•8815. <br />2. All work shell be pedo�meA in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards end Specificatlons <br />3. Cell Locetion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />Approved for Construction / / Date <br />/`�� ��G�---?-/%-�I <br />INAL INSPECTION Date <br />Appr• �ed as Constructed <br />everen PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everet6 WA 98201 <br />Phone: 259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unde!signed owner/applicant hereby agrees to hold end save harm- <br />less the City ol Everett Irom any end all claims for demagas, costa <br />ezpenses, or causes of action that may arise because ol Installation <br />and mainlenance o1 the improvemenl or other right•ot-wey use hereto <br />applied lor and further agrees to remove same upon notice from tha <br />City and lo replace public propeAy damaged thereby. <br />-" � > : <br />SignaWre f Applicent � " Date <br />WORK AUTHORIZED BY TI115 PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />