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Date �D -2�� —�i 6 � <br />AnPhcation For � 1 I �'� L�S � � J 4'X <br />PUBLIC WORKS PERMIT �.;��jU, �{„� <br />Print or Type Only <br />ED <br />Maihng <br />Puni�c Wons Per�n . <br />Bioo �eot • _—.. <br />r,���m wmka Fee s <br />Tola� Fee <br />LPSS AD�I InP Partl S <br />Baiance Due s <br />96z��_ <br />L� 1 p�—-1 S'� �• S•�-✓• M uK� l.T� 0 <br />lddr(n55 C�ty Z�n <br />NAsS� rtor��N,En s�-►-� �=r <br />Applicani Maihng Address <br />Desr,iibe Proposed Work I—�r. E TO M•4Kr � <br />. . , f <br />City Z�P <br />353-9�9 7 <br />�zu-sq�7 <br />Phone <br />R wE w�R Y Fo►' a c� �_ <br />�^� �l,alc.'� ��-�- <br />Pro�ecl Add�es51�� knownl � — " � <br />qryar,h four 14) coPies oi P�ans lor proposed wo�Y. - Draw to scale nnd note ����� erline o� SVee� abie <br />• Propr.riy Lmes • Indicaie Norih <br />• OuUine and dimensions o� all existing and � ShDw any propased ��aAi�i9 changes <br />,iroposrd siruclures on iho Inl � Show measurements <br />• EKistinq and pioposed uLlille; <br />PERMIT GONOITIONS <br />1. PII calls lor inspection shall be made 24 hrs. in advance - phone 259•88i 0. <br />2 All work shall be perlormed in accordance with this permit and cmrent City ol Everet� DesiGn and Conslrudion <br />Standards and Specihcations. <br />3. Call location Underground Service 48 hrs. belo:e you dig. TOLL FREE NUMBER 1:800-424•5555. <br />� � �1i1 L�uaT��.� <br />� �/` Nc.c,✓ Q/a^� j <br />, <br />-- /. <br />i�, /c;'-Z f -S� <br />Approved lor Conslruclion Date <br />FINAL INSPEGTION <br />Appwvr,d as Gonstiucted <br />�,�,�,�iq� PUBLIC WURKS DEPARiMENT <br />� 3200 Cedar Street <br />Lvernl�, WA 902C1 <br />phnne Ti0�gH10 <br />W <br />H <br />� <br />� <br />� <br />� <br />♦ <br />� <br />0 <br />� <br />� <br />O <br />a <br />ACKN01'JL[DG[MENT OP CONDI110N5 <br />The unAcis�yned owneNapplicant hereby agrees to hold an<i save harm� <br />Iess the C�ty ot Everett Irom any and au cla�ms lor damages costs. <br />expenses. or causes ol action ihat may anse becausa ol mslallation <br />anA maintenance ol Ihe imp�ovement o� other nght�ol-way use her=to <br />applied tor and lurlhe� agrees to remove same upon notice irom Ihe <br />Cily and to replace public property damaged ihereby. <br />Date Date <br />Signatwe of APP��cant <br />WORK AUTIIORILED BY THIS PEFMIT MUST DE STARTED WITH1�l <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANC[LLED BY THE CITY UPON ANV STOPPAGE OF WORK ON TNIS <br />PROJECT OVER 90 DAYS DURATION. <br />