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Date �� �� `s9 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />qpplicant <br />Maihng <br />g� <br />Oescnbe ProPosed Work _l��1�'t ��.�7P��-��4�O�F O(- /���� <br />I <br />Zip <br />Prolect Address lil kaownl " - <br />mtach four 141 cooies of Plans lor proposed work � Draw to scale and note the lollowing as apPlicahle: <br />• ProPertY Lines <br />• Outline and dimensions of all existing and <br />proposed slructures an the lot <br />• Existing and prOposed u�ili�ies <br />vupLc Wo�hsPmnnt � ( -, ��-1.�� -- - <br />61�g Oepl. � — -- <br />PuM¢ wor� x F cc <br />Tolrl Gee S - - <br />l¢$SA�01 frtn f'T�J `S! F �y/� <br />�dI�I1f,C�11f J ��"�C_ <br />• Centeriine of sireet <br />• Indicate Norih <br />• Show any proposed yrading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall 6e made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedamed in accordance wilh this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />` ��L ��� 1� � �� �C� <br />. ll , <br />Approvc (or Construction .. Date <br />� �_�� �/-/�- y's <br />FINAL INSF'ECTION Date <br />Approved as Construcled <br />everelt PUBLIC WORKS DEPARTM[NT <br />� 3200 Cedar Street <br />Everetl, WA 99201 <br />"hone�.259�8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ot Hverett Irom any and all claims tor damayes, costs, <br />expenses. or causes ol action Ihat may arise because ot installation <br />and maintenance ol ihe improvement or o�her right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Ci�y and to replace public proUerty damaged ihereby. <br />�� ._� <br />S� a e'o iCant Date <br />ORK�AUT RIZEO 8Y TIiIS PERMIT MUST BE S?ARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />