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� / <br />� . • i/I • <br />Application For <br />PUBLIC WORKS P�RMIT <br />Print or Type Only <br />yt N <br />APUhcant <br />Mailing <br />Mailing Address <br />Descrlbe Proposed Werk �� <br />Proiect Atldress lil knov+nl <br />Giry <br />��n <br />Attach lour �4) copies ol plans br proposed work � Draw to scale and note the following as applicable� <br />• Propeity Lines <br />• Outline and dimensions ol all ex�sting and <br />propose0 Siruc�ur¢5 On Ihe lol <br />• Ealsting and prOposed uti6ties <br />� � V <br />� 31,.. <br />PupLc N'a�Fs Vrj%'^�y���� �% <br />F3i�0 �eol.. =� J,�I ��__ <br />PubLc wnrAs Fee � <br />re,,: F�� — <br />less Aod �r•• Pr�� $ <br />'7�jCK% <br />eaia�c� o�c S � _ <br />• Ce�terhne of street <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hrs. in advance - phone 259•8810. <br />2, All work shall be pertormed in accordance with this permit and current City of Everetl �esign and Construction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs, belore you dig. TOLL FREE NUMBER 1-500•424•$555. <br />!�' l �1 � / <br />�,z�%%7<'.'!-'.� ,5� / '�L <br />Approved lor ConscruCli / / Date <br />/ � <br />��'+�-� L /-,l 3 S'� <br />FINAL INSPECiION Date <br />Approved as Constructed <br />everelt PUBUC WORKS DEPARTMENT <br />� 3?00 Cedar Street <br />Everett V.'A 99201 <br />Phone:259�BB10 <br />ACKNOWLEDG[MENT OF GONDIT�ONS <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned owner/applicant herehy agrees tu hold and save harm- <br />less the Cily ol Everetl Irom any and all claims for damages, cosis. <br />enpenses, or causes ol action Ihat may arise because ol �nsf>Ilalion <br />and mainlenance ot the improvement or other nght-of�way use horeto <br />applied lor and iwthcr agrees in remove same upon notice ironi the <br />Clty and to replace puUlic properiy damaged thereby. <br />l 1' .�/ � �/ ��j ' <br />rJ / <br />iQ �ufe O� ApplicaN �— <br />RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAY� i1F DATF PERMIT IS ISSUED AMD THEREAFTEF IS TO <br />BE DI�IGEtJ�LY PURSUED TO COMPLETION. THIS PEFMIT MAV BE <br />CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />