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Date�v—I <br />Applicatio� For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1`i�l)��CYJU�ASI'�IT' � �—y/�/�' �{7���,� <br />6i�J Dno' � _�_ j LJ�I.A/—�^../l <br />v,�eec wonR ree <br />,o�r�.�� g -- <br />less nno� Fsr VeiJ $ <br />F�alance Our i <br />qpplicant Mading P.ddress G�ty Zip Phone <br />Prolect Address I�� knownl ��L(��' 7-s ' <br />Attach four (4) copies ol plans for proposed wo�k � Draw to sr.ale and note Ihe lollowing as appGcable: <br />• Properly Lines <br />• Outline and dimensions of �tl existing and <br />prOpoeetl 5lructure5 Cn the lot <br />• Ezisting and propos9d uiildies <br />• Centerline ol street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•88�0. <br />2. All work shall 6e peAormed in accordance with this permit and current City of Everett Oesign �nd Construction <br />Standards and Specifications. <br />3. Calt Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�/ ) � . <br />/ l;��l,< «�c-i�,C�_s" %�—.�_°i>>i� .-C���i ,��rc� i���C�� <br />Approved lor Conslruction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireel <br />Everetl, WA 9A201 <br />Phone: 259-ti810 <br />, � <br />- �//��h, <br />TJ`.,� <br />� _ � ,ry <br />ACKNOWLEDGEMENi OF GONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The unA^rsigned owneUapplicant he�eUy agrees to hold and save harm- <br />less the Clty ot Everelt from any and all claims lor damages, costs. <br />e•penses. or causes of action Ihat may arise because of installalion <br />and maintenance of the improvement or other righbol�way use hereto <br />applieA for and further agrees to remove same upon notice irom ihe <br />City and to replace pubfic preperty damaged ihereby. <br />Signature ol Anplicanl Date <br />WORK AUTIIORIZED BY THIS P[RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAhTER IS TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS <br />FROJECT OVER 90 DAVS DURATION. <br />