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n 1�_� <br />- 1 1 <br />/_�,_,�- <br />Date ► f. , `� r <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Prinl or Type Only <br />�E-/7v <br />Pe�ec Woika Perm�l.S ` � ,� - <br />BiEO D<o1. • ��'- .- <br />Pu01�cWo�MSFev 5 <br />To�m Fcc — <br />Less POoI icrt Pa�O 5 -- <br />a�ir�«o�� S ZD <br />�� _ -- <br />Applicani <br />Mailing�ddress City Zip Phone <br />. — .. � .^. 1 �G — '� / I_� If Y�/ ^ti <br />Describe Proposed Work <br />Project Address (if knawn) <br />Atlach lour (4) coPies ol plans lor proposed work � Draw to scale and note Ihe lollowing as applicaUle� <br />�� <br />• PrOPe�tY Lines <br />• Ou�line and dimensions ol all existinc� and <br />proposed slrucW res on ihe lot <br />• Existing and proposed utillties <br />� <br />• Centerlme ot street <br />e Indicate Norlh <br />• Show any proposed gradin9 changr.s <br />• Show measurements <br />PtRM4T CONDRIONS <br />1. AU calls lor inspection shall be made 24 hrs. in advance- phone 259$810. <br />2 All work shall t= pedormed in accordance wilh �his permi� and currenl City of Everelt Desi,;n and Consiruc�ion <br />SL .�dards and Specilications. <br />3. Call Localion Underground S�rvice 48 hrs. belore you dig. TOLL FREE NUMBER 1•II00•424•5555. <br />Approved as Gonsiructetl <br />evemtt PUBLIC WORKS DEPARTMENT <br />� 3200 Gedar Streel <br />Everett. \'JA 98201 <br />Phonr,:259�8810 <br />ua�e <br />7,fe� <br />Date <br />ACKNOWL[DGEMENT Of- CONDITIONS <br />� <br />� <br />�w <br />_ / <br />� <br />a <br />ihe undersigncd owncr/applicant hereby 29ree5 to hold � � ave harm� <br />less the City of Everet� Irom any and all claims lor d !��s, cosis, <br />expenses, or causes o� action �hat may arise becous stalLd�on <br />and maintenance ot the Improvement or other nohl-ot - ise herelo <br />applied lor and lurther agrees to remove same upon ��., :e from ihe <br />Ci �d to replace public property damag�d thereby. <br />� � <br />/' <br />� <br />, <br />' .� ,�- .'�.� i� ....r�� �' � Q��� <br />S nature oi App nt Dite <br />WGRK AUTHORIZED Fi i41S PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE f-.-":dIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS f GRMIT MAY 6[ <br />CANCELLED BY THE CITY UPON l.NY STOPPAGE OF IVORK ON 7HI5 <br />PROJLGT OVEF JO DAYS DUFiATION_ <br />