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Date��f%�d l <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />V, <br />c�iy <br />Descnbe Proposed Work <br />v„m�c wo�ws Perm�`u • <br />D�np Oeo�.+ _�j—q���� - <br />f�umicwo«srec S '----�� —� <br />io�a�Fer � - <br />LessAnn� PoePa�a S — <br />eri,��� o�� S <br />�riG� 35 3 -� / <br />Lp Phone <br />Pr01eC� Address (if knownl ��� �n � � IN � ����s; <br />4ttach four (4) copies ol plans for proposed work � Draw to scale and note tna tollowing as appGcable: <br />• Property Lines <br />• Outline and dimension5 Of all ezis�ing and <br />proposed siructures on ihe lot <br />• Exlsfing and proposed utilities <br />• Centerline ol slreet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be maCe 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Ca�l Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•600•424•5555. <br />Approved Por Consiruc�ion <br />� <br />��.�.>�� � ,� � �� �� � � ti� � <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EvereU, WA 98201 <br />Phone:259-8810 <br />,-,����,�,�, <br />,, ;� � _.�; , <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/apnlicant hereUy agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims br damages, costs, <br />expenses, or causes of adion that may arise because of installation <br />and maintenanr^. ol Ihe improvement or other right-ol-way use hereto <br />applied for and funher agrees to remove same upon notice Irom ihe <br />Date City and to replace pubhc property damaged thereby. <br />Date <br />Signalure of Applicant Date <br />WORK AUTI�ORIZED 9Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGC-NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANGELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9Q DAYS DURATION. <br />