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Date��i0 <br />Application For <br />PUBLI�C WORKS PER�IAIT <br />Print or Type Only <br />PubLc Worhs Pe�mi '� — ��� <br />OiOg DeO�-• � <br />auoi�c worxs Fee a <br />iotnl Fee <br />less Aoat Fec Pa�itl S <br />Balance Due $ ��� <br />� ppl� Maihng Address Cdy Zip Phone i <br />Describe Propo�^d Work ..L��G, <br />Prolecl Addres: lil known) <br />— �_FGcJ <br />Attach four (4) copies of plans lor proposed work • Draw to scale and note ihe following as apPlicable: <br />• Property Lines <br />• Outlir.e and dimensions of all existin9 and <br />proposed slruc�ures on ihe �ut <br />• ExiSting and proposed utiliiias <br />• Cenlerline ol slreet <br />• Indicate North <br />• Show any proposed �rading changes <br />• Show measureinenls <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 performed in accordance with this permit and curreN City of Everetl Design and Cons�ruction <br />Stande�.ds and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREC NUMBER 1•800•424•5555. <br />Y ��µ��c�J �S,v�+-� �na< ilu.ee� �-to /1t /Lf foxa�i2tis�".c6' <br />.,�v .Scu-'7`���c-�,�� ��G� Coxtti� �-�u� f'";6z'tc� cvoz.�- <br />�,�� �L� .25� 5800 �e�vu ��-� Cc.b?i= �' ����`��/` <br />�� <br />r�--,-;��'- - _ <br />i�ii_ - �iva��-- r��Bc' <br />Appro forConstruc,�io � ate <br />/ f //�� � �L�p <br />-/"�i!L� <br />FINAL INSPECTION L' � Date <br />Approved as Construcled <br />everett PUBLIC WORKS DCPAR7MENT <br />� 3200 Cedar Street <br />Everett. WA 9820t <br />Phone:259�8810 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />1� <br />� <br />� <br />O <br />The undersigned owner/apPlicant hereby agrees to hold and save harm� <br />less ihe City ol Everelt Irnm any and all claims br damages. costs. <br />expenses, or causes of action that may arise because ol inslallation <br />and mamtenance of the improvement or other right-ol�way use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />Cily an to replace public property damaged ihereby. <br />ig ature ol pplicant � n 3 Date <br />WORK AUTHORI7ED BY THIS PERMIT h1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY 8[ <br />CANCELLED BY THE CITY UPON ANY S10PPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />