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Date�s��� <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />�„�., .��,�..��,m�. 8% ts s� __ <br />��,,, o,.�� . _�9�aasrrr�_ <br />c��nu� wo��s a�� g _ -------- � <br />to�nl Fen <br />LessAnp� FnePa�a $ — <br />❑alanr.r Duc $ �� �� <br />PP�n� 1/�Nn�p/p,1 fi_ c��'C7 �=„riarsn,, A2 ��P�atf- 9�m�F 3s3 d�'r4� <br />Owner Mailing tltlress City 2ip Phone <br />Address <br />Descnbe Proposetl Work /���� S'r � <br />Pro�ecl Address Iil known) <br />83os - X/av.e•; b�: <br />Lp <br />Attach lour (4) copies of plans IM proposed wo�k - Draw to scale antl nole Ihe tollowing as apUlicable: <br />• Property Lines <br />• Outline and dimensions ol all ezisling and <br />proposed sirucWres on Ihe lot <br />• Existmg and proposed uliGties <br />• Cenledine cf St�eet <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenls <br />IS <br />PERMIT CONDITIONS <br />7. All calls lor inspection shall be made 24 hrs. in advence • phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. L•elore you dig. TOLL FREE NUMBER 1-800•424-5555. <br />�_ � <br />FlNALINSPEGT�ON L' <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�E810 <br />QC'i <br />Dale <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />The undcisigned owner/applic;.nt hereby agrees to hold and save harm� <br />less the City ol Everell Irom any and all claims tor damages, costs, <br />expenses, or c.auses of action that may arise because of installation <br />and maintenance of the improvement or other right�ol�way use hereto <br />��plied for and lurther agrees to remove same upon notice Irom ihe <br />1City and� to repl�ce put�le rop�rty damaijed ihereby. <br />\ / <br />1 i <br />� I �{. <br />��/ � �_ <—c) <br />`_�1 / ����.' �Ca.,w( C � ` L+/ <br />Signalure ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUS�i BE STARTED WITHIN <br />1B0 DAYS OF DATC- PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT !.1AY BC <br />CF.NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />