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Date���.� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ma <br />Describe ProUosed Work <br />Prolect Adtlress (il knOwN <br />c��v <br />V�UUIiG \SOIFS I�n�rtiil • _ <br />eiae. oen�. • —�-`-��'�.5� _ <br />Publ¢Workefee S — �� -- <br />roiai Fco <br />Lass ApYI !ee Pan1 5 -- <br />flalancn0ue � <br />c18 L�' 3 �S Z -!oS <br />2ip Phone <br />�/%Z-� �i,�'7-�7/, <br />Zip Phone <br />AUach lour (4� copies ol plans lor proposed work � Draw �o scale and note Ihe following as apP�icable: <br />• Property Lines <br />• Outlme and dimensions ol all existing and <br />proposed structures on ihe lot <br />• E�isting and proposed u�ili�ies <br />• Centerline ol sireei <br />• Indicate Norih <br />• Show any pr�npsed gradinc� chan9es <br />• Show mcasurer.mits <br />PERMIT CONDITIONS <br />1. All calls br inspection shall be made 24 hrs. in advance - phone 259•88i 0. <br />2. All work shall be peAormed in accordance with this permit and curreN City of Everett Desi�n and Construdion <br />Standards and Specilications. <br />3. Call Location Under�round Service 48 hrs. before you Aig. TOLL FREE NUMBER 1•800•424•$555. <br />J/�[/ /}--�J�/%�11.( � / �l.i � <br />v <br />Approved for Conslruction <br />/�fi'�CJ' <br />AGKNOWL[DGEMENT OF CONDITIONS <br />� <br />N <br />O <br />a <br />The undersigned owneUapphcant heieUy agi�es to hold and save hnnn- <br />I less the Gty of Everett from any and all claims for damages, costs. <br />expenses, or causes of aclion that may arise because of installation <br />and maintenance of the improvement or other right-ol-way usc hereto <br />applied lor antl lurlher agrees to remove same upon nohcc Irom thr, <br />Date City and to replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Construded Signature ol Applicant Date <br />WORK AUTHORIZEO BY THIS PERMIT MUST B[ STARiED WITHIN <br />i�i���t PUBLICWORKSDEPARTMENT 1B0 DAVS OF UATE PERIv11T IS ISSUEO AND TH[REAFTER IS TO <br />� 3200CedarSlrecl BE DILIGENTLY PURSU[D TO COMPLETION. THIS PEFMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON FNY STOPPAGE OF WORK ON THIS <br />Phone:259�8810 PROJCCT OVER 90 DAVS DURATION. <br />