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Date_.�L�q %"� <br />" / � '" ' ''.: � n„�,ec w�,.ks r+..,rt� <br />Applicalion For <br />PUBLIC WORKS FERMIIT <br />Frint or Type Only <br />[:in9 Di�Dt . .__� �_p � - . <br />vuoucwor4siee p _--�_--- <br />TO�TI if�! J __ <br />LesSRppl FnnPa�p S <br />Baianrp0ue $ <br />�`� r� k �9y,6 <br />-'�Mas��� �� �l� i� - Z� r�� ,li�= , _ � ,., _ „ 3ss <br />Address <br />Descrihe Propnsed Work <br />City <br />Project Address I�� known� S J ,e� � <br />,R.,/�__ rij <br />Attach four (41 copies ol plans ic� proposed work - Draw to scale antl note thc lotlowing as apPlicable: <br />• Property Lines <br />• Outline and dimension5 0l all existing and <br />proposed strucWres on ihe lot <br />• Ezisting and proposed utilities <br />• Cenlerline of sireet <br />• Indicate North <br />• Show any proposed gratling changes <br />• Show measuremenis <br />PERM�T CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8870. <br />2. All work shall be peAormed in acwrdance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 7-800•424-5555. <br />PIC� /"/"_%_�%'7/% �j � � — <br />� �L �^! : /. Y:% <br />I <br />APProved lor Construct�on Date � <br />FINAL INSFECTION Date <br />Approved as Constructed <br />everett PUBLICWORKSDEPAR7MENT <br />� 3200 Cedar Slreet <br />Everetl, V✓A gA201 <br />Phone: 259�8810 <br /><_�/,/G /djr�-z-%-1- <br />J��,�/_ •97� <br />W <br />� <br />� <br />� <br />�CKNOWLEDGEMENT OF CONDITIONS <br />The underslgned owner/applicant hereby agrees to hold and save harm� <br />less the City ol Everelt �rom any and all claims lor damages, cosls, <br />eapenses, or causes ot action that may arise because of installation <br />and mainlenance ol Ihe improvement or other right�ol-way use hereto <br />aoplied for and lurther ag�ees to remove same upon notice trom the <br />Gity and to replace public property damaged Ihereby. <br />Signalure ol Applicant -- ,�a�e <br />WORK 4l�THORIZED BY THIS PERMIT MUST BE STARTED IMITHIN <br />180 D.� %'; OF DATE PERMIT Ij ISSUED ANO THERFAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. 7HIS PERMIT MAY BE <br />CANCELLE� BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />