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,� � <br />Date 7-��.- <br />Applitation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />owner <br />�{ ht <br />App�icant <br />DeScribe PrOpused Work <br />Project Address lil knownl <br />Address <br />Mailing Address <br />nupecWorksPermn � <br />bidB DeUt • l _��..� <br />VJIII�L WOIAS FEC <br />TOlal fcc g _� <br />less Appl. fge Pm0 5_ <br />Baiancc Dur 5 __ <br />LP Phone <br />Attach lour (41 copies of plans br proposed work - Draw to scale and note Ihe followmg as anPlicable: <br />• ProPertY Lines <br />• Outlme and dimensions of all existing and <br />proposed slructures on Ihe lot <br />• Existing and proposed utilities <br />• Centeriine ol streei <br />• Inditale 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 pedormed in accordance with ihis permit and current City of Everetl Design and Consiruction <br />Standards ano Specitications. <br />3. Call Location Underground Service 48 hrs. before you aig. TOLL FREF NUMBER 1-500-424-5555. <br />��� /� . ; ��_ � f �l! � �� � �._ ti � .!' <br />y- �L�f � C�C%'i�'� / �.?��,�._� . „U' ��� �� C _ <br />l' , <br />Approved tor Consiruction <br />FINAL INSP[CTION <br />Approved as Consiructed <br />everelt PUBLIC WOFKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />��j;�,7 <br />,fi-��� 3� <br />?-�::;- �3� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />The un6ersigned owner/applicant hereby agrees to hotd and save harm- <br />less the City ol Everett Irom any and all claims lor damages. cosis. <br />— I expenses. or causes ol action that may arise 6ecause o( installaUon <br />and maintenance of Ihe improvement or other nght-ol-way use hereto <br />Date applied lor and lurther agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY TI115 PERMIT MUST BE STAR7ED WI1111N <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMII Iv1AV BE <br />CANCELLED BV THE CiTY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />