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� <br />Date�czs� i <br />�;op�icalion For <br />PUBLIC WC�RKS PERMIT <br />Print or Type Only <br />City <br />Mailing Address <br />Describe Proposad Work � ` `C ' , ' �•C � 1 -- <br />Project Address �if known) <br />r�m�= worvs i�o�Qmn . <br />ome oent • �L � <br />r�o��� wo�x� rea S <br />lolsl fov <br />LCSeFpPI FcePaid s <br />BlIp11CC �IIN S <br />��p rnuim <br />Attach Ieur �4) copiec of plans lor proposed work - Draw to scale and i�ote the following as applicable: <br />• Property Lines , � Centerline olstrset <br />• Outiine and dimansions ot ell existing nnd • Indicale North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utililies • Show measurements <br />PEfiMIT CONDITIONS <br />1. All caile lor inspection shall be made 24 hrs. in advance - phone 259•88i 5. <br />?. All work shell be pertormed in accordance with ihis permit and current City ol Everett Design and Construttion <br />Standards and Specilicationa <br />3. Call Location Underground Service 48 hrs. betore You dig. TOLL FREE NUMBER 1•B00'424•5555. <br />f�',,� �z ���-��t` �:.������ <br />Approved tor Construction Date <br />FINALINSPECTION Date <br />Approved as Constructed <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett. WA 98201 <br />Phore:259�8875 <br />7 8-8% <br />�G� <br />ACKNOWLEDGEMFNT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City ol Everett Irom any and all claims for damages, cosls, <br />expenses, or causes ot ac�ion lhat may arise because of inqtallati0n <br />and maintenance ot �he improvement or other righLol-way tlil�Aereto <br />applied for and further agrees lo remove same upon notice �rom ihe <br />City and to replace public property damaged therehy. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br />BE DILIGENTLV PURSUED 10 CO.'viPLEiION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 D�YS DURATION. <br />