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Date � / `� <br />qpplicaiion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P�pL� \Yo�ks Ge�mi� • �/��> <br />aiae� o�a� . 90 /a yv �3 <br />i <br />PUUIir 1Yorkf Pne <br />iolalfee $— <br />Less fY��l. Fee Pd�� $ — <br />/ <br />9alance Duc S �-0 <br />�� /y� � G'Ast/S l£�- O�Rex G z 9 y L v,✓_✓eop 4 S a 3 L 3 Y F-3 S3 % <br />Owner Mailing Atltlress City Zip Phone <br />d-����L./ - <br />Applicant Mailinc� Atldress City Zip Phone <br />Describe I'roposed Work �iYG� .Sf ✓L � <br />Project Addres�, lil known) <br />Attach lour (4, r,pies oi plans lor proposed work - Draw to scale and note ihe lollowing �s aUPlicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on ihe lot <br />• Existing anC proposed ulilities <br />• Centerline ol street <br />• Indicate Nor�h <br />• Show any pioposcd 9ratling changes <br />• Show measuremeNs <br />PERMIT CONDITIONS <br />1. All calls ter inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be perlormed in accordance with this permit and curreM City of Everetl Design and Consiructi0n <br />Siandards and Specifir.ations. <br />3. Call Location Underground Service 48 hrs. betore you dig, TOLL FREE NUMBER 1•800•424•5555. <br />+�- �1 `�. �/z5/� <br />P.;,�r�e�d for Construction ' r Date <br />C�^/`I �`J `�"— 9p <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evcret[ PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Evereft, WA 98201 <br />Phone:259�8810 <br />A( �iAl )VJLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />Thc undersigned nuner,�applicant hereby agrees to hold and save harm� <br />Iess ihe City ot Everett irom any and all claims for damages, cosis. <br />ezpenses, or causes ol action that may arise because of installation <br />and maintenance ol �he improvement or olher right�obway use herelo <br />applied for and �urfher ayrees to remove same upon notice trom the <br />Ciry and to replace public prpperty damaged thereby. <br />_t�-c�L� <br />WOd1K AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 tydYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DfLIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV 8[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ?HIS <br />PROJEGT OVER 90 DAYS DURAiION. <br />