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Date�� <br />Application For <br />PUBLIC WORICS PERMIIT <br />Prin+ or Type Unly <br />PubI��R'n��i Psrmil • � �� �� � <br />maa ueni.. ��— <br />ruohc worFa reo <br />TolxlFoe S <br />Lxif Appl. Foe Pqid S /�� <br />Bainnce om S � <br />Atltlr¢55 <br />Describe Proposed Work ��� � �� � ���� �� � <br />Project Address (il known) <br />Gily LIp YYJf12 <br />Attath lour (4) cOpie& of Olans for proposed work - Draw to scalo and nole the following as appliczble: <br />• Property Lines • Centerline o� streel <br />• Outline and dimensions ol all ezisting and • Indicale North <br />propoeed structures on the lOt • Show any proposed grading changes <br />• Exiating and proposed ulililies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be m�de 24 hrs. in advance - phone 259-881 5. <br />2. All work sheli be perlormed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Specilicatlona <br />3. Cal� La:ation Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 1-800•424•5555. <br />% �c' C'p�vsr,PvcTFo /�r.�' 9,o�i�c�� S�7E PC�.t/ <br />1�HTE,D i-J_B-.�� .�nycf/,�DJ <br />��.,,r'� � _ y!B �7 <br />Approved for Con ructi%Lj� Date <br />� - � • Fi <br />FINAL INSP TION Date <br />ApNroved as Constructed <br />evemtt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone 259-0815 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />H <br />� <br />�J <br />� <br />� <br />O <br />a <br />The undersiyned owner/appli,;.M herehy agrees to hold and save harm• <br />less the Cdy ol Everetl Irom any and all claims for damaqes, costs, <br />eapenses, or causes of action that may arise because ol installation <br />and maintenance of �he improvement or other righPo4way use here�o <br />applied for and further agrees to remove same upon notice trom the <br />City and to replace publi roperty dama�ed thereby. <br />/ � / <br />;%'., . .����f//' r .,.-�e � ��! �,Jb 1 <br />Si ature ol Applicant 5�J Date <br />WORK AUTHORI2ED BY TH�S PERMIT I+tUST BE STARTED WITfiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETiON. THIS PERMIT MAV BE <br />C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURATION, <br />