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Date_L� O � <br />ApPlica�ion For <br />PUBLIC WORKS PER"'lIT <br />Prinl or Type Only <br />6 I 27 <br />✓ <br />cimuc vJods Pxrmit ^ G1 <br />CIic19 �ePl. � �_ �j�'I r��— �. <br />Vunim Wons Fee <br />Tolnl Fce S — <br />Le55 Ann� Fee Pam S <br />/ <br />�alanc� Duc $ �� � — <br />. ., � �� . ��� � .� . ' q • -`r ._�! . <br />. .. <br />-�4YY'l� <br />AppGcant M�ihng Address City Zip Phone <br />Descnbe Proposed Work <br />Pro�ect Adtlress UI knownl <br />Attach lour 141 copies ol plans for proposed work - Draw to scale and note ihe lollowing as applicable: <br />• Property Lines <br />• OutGne and dimensions ot all eaisting and <br />proPosetl siructures on ihe lot <br />• ExiSUng and propOsed uliG�ies <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and curreN City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5$55. <br />:: �,✓/'i/�7 _ : .. <br />�r' . C�:C %-i� '/�"� � <br />Appr ed for Constr ¢tion <br />� � -�� .��i �/��/ <br />FINAL !NSFECTIO � <br />Approved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everetl, WA 98201 <br />Phone:259-8810 <br />,� <br />Dale <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby a9rees to hold and save harm- <br />less the Ciry ol Everelt Irom any and all claims for damages, costs, <br />expenses. or causes ol action that may arise because of installation <br />and maintenance of the improvemem or other right•obway use hereto <br />applied for and lunher a�rces to remove same upon notice from the <br />Ciry and to replace pu ic property damagetl thereby. <br />nalure o�p cen �' ODatc <br />WORK AUTHORI BY THIS PERMIT MUST BF STAR D WITHIN <br />180 DAYS OF DATE P[FMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />