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Date�_L?�_� � <br />Applicalien For <br />PUBLEC WORKS �ERMIT <br />Print or Type Only <br />Mailing AAdress <br />I PupLC.1Yo•Mx P..T`y-��-.'���� <br />u�nq oeu�. • �G-.�_ <br />Pu�e< Worva Fce <br />,o�.� F..e s _ <br />LessPnol fe�Pa�� 5 -- <br />e.,i,,�,:�o„�, 5 _ <br />��.�'t'� �;�--� ,�- <br />Cdy Zip Phone <br />qpp�i�a�� � Mallin�Address� � G�,ty Zip Phonr <br />Pro�ect AtlA�ess Id knownl <br />Attach lour (d) copies ol plans tor propused work � Draw to scale and note the �ollowing as apP�icable: <br />• Propeny Lmes <br />• Outlinc �nd dimensions ol all existinp a�A <br />proposed structures on Ihe lol <br />• Existmg and proposed utildic5 <br />• Cenle�line ol street <br />• Indicalc North <br />• Show any p�oposed gradmg changes <br />• Show measurert�enis <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259-$$i 0. <br />2. All work shall be peilormed in accordance with this permit and currenl City ol Everelt Design and Construction <br />Standards and Specilicalions. <br />3. Call Location Undergrountl Service 48 hrs. beture you dig. TOLL FREE NUMBER 1-800•424•5555. <br />,t/�� �'�v%�� �j�,e,�� � <br />,s--� —B 9 <br />Approved lor Construction Date <br />FINAL INSPECTION ���� <br />Approved as Constructed <br />everelt PUBLICWORKSDEPARTM[NT <br />� 3200 Cedar Slreet <br />Everett, WA 99201 <br />Phone:259�8810 <br />ACKNOVJLEDGEMENT OF CONDITIONS <br />Z�I <br />O' <br />��A <br />V♦ <br />O <br />a <br />The imdeisigned owner/applicant herehy agrees to hold and save harm- <br />less the Cily ol Fverelt trom any and all claims lor damages, cosls. <br />expenses. or Causes of aclion Ihat may arise because 01 instsllalion <br />and mainlenance of Ihe improvement or other right�of-way use hereto <br />applied for and further agrees to remove samr, upon notice irom the <br />City: nd to replace public property damaged thereby. <br />Signa�ure ol AppliCant Ua�e <br />WGRK AUTHOR12ED BY THIS PERPAIT MUST B[ STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br />RE DILIG[NTLY PURSUED TO COMPLETION. THIS PERPd1T MA1' BE <br />CANC[LL[D BV 1HE CITY UPON AtJ1' STOPPAGE OF WORK OP: THiS <br />PROJECT OVER 30 DAYS DURATION. <br />