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Date�, -, � <br />, <br />� � <br />ApP��caticn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Appl�cam <br />� <br />Mailinp Address <br />Descnbe Proposed Work l /j�� ' � ` ,� r��� � � <br />Prolect AdAress lil knownl <br />Attach lour 14) copies of plans lor proposed ��o�k - Draw to scale antl <br />• Pronerty Lmes <br />• putlme and dimensions ol all ezisting and <br />proposed strudures on ihe lot <br />• Existmg and proposed utilitics <br />�, <br />P�Abc WorMs Petmi� • <br />Filll9 DePI. � r�(- / /�� _ <br />Pubi�c WorFs Fe�+ <br />iotrl pee 5 — <br />LC55 ApO� �EP PTid � <br />BnIanCCDun $ <br />� _ <br />�� t , � ,�_ �� �� �����t�' _, - <br />City � ` Zip � �none <br />'1 1 <br />�`_ �=:.� �� , <br />, ., <br />Cny Zip Phonc <br />followmg as appliwble�. <br />• Centerline of street <br />• Indicate North <br />• Show any proposetl grading cnanges <br />• Show measurert�en�s <br />PEI NITCONDITIONS <br />1, All calls for incnection shall be made 24 hrs. in adva�ce - phone 259•88�0. <br />2. All work shall be pedormed in accordance wilh thi�; permit antl cwrent City ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you aig. TOLI FREE NUMBER 1� 900-424•5555. <br />;1�T %_�,";j . <br />> <br />��:�/1��� � /':; <br />J�/Y�' �'� �T <br />Approved for Construclion <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />everelt PUBUC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett. WA 98201 <br />Phcne:259�8810 <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />H <br />� <br />O <br />a <br />The undersigned cw�nedapplicant hereby agrees to hold and save ha�m� <br />less the Ciry ol Everetl from any and all claims for damages, cosls, <br />expenses, or causes ol action Iha� may arise because ol installation <br />and maintenance ol the improvement or other right-ol-way use hereto <br />applied �or and further agrees to remove same upon notice Irom Ihe <br />City and to replace public property damaged ihereby. <br />Signature ol Applicant Date <br />WOFK AUTHOR12ED BY Th!IS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS i0 <br />BE DILIGENTLY PURSUE� TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON `• HIS <br />PROJECT OV[R 90 DAVS DURATION. <br />