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rAx <br />L <br />tPubl� <br />PubiA. Perm <br />Date . H— <br />Application F or <br />WORKS PERMIT rhe`°° 5PUBLIC Poe Pei° $"c <br />Print or Type Orly <br />Myy"" <br />A ?] pC <br />� H <br />9 H f/r <br />HEX <br />k C] <br />H �1 <br />Q H Q <br />tq H <br />R� <br />x e <br />MOB <br />IH-I y C! <br />9 H z <br />H H <br />N <br />H <br />f]t7y <br />RMV <br />to <br />Hq to <br />O En <br />(A h <br />Describe Proposed Work <br />Project Address (if kr own) <br />Attach lout (4) copies of plans for proposed work , Draw to scale and noteCeniterime of street <br />ing as �ble: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-555 . <br />� l <br />C )UT T5. <br />Aj <br />! r <br />— Z—t — SR <br />l:,,IAw <br />i <br />Construction <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone'. 259-8610 <br />i <br />Z <br />O <br />N <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm <br />less the My of Everett Irom any and all claims for damages. costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other tightol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS <br />190 DAYS PERMIT WITHIN <br />OF DATE PERMIT IS ISSUED AND THFREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />