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Date���� <br />Applicetlan For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />8�-!�0 <br />Publm Wo�ke Permlt � ---�—� <br />c>� i ,�.i�- <br />omo oao�. • _psa—`-f-s-� <br />Pu�Irc Wodafm s —_ <br />Tolel Fee <br />Lea� Rp0< <ee Pe�J s O <br />9�IenceDue s �O — <br />c�ty ��� <br />Describe Proposed Work <br />SloZc� - Sou.�lC f�l/E <br />Proloct Address (if k�ownl <br />Attach lour (4) copies o1 plans for proposed work - Draw to scale anA note � C�^�;ewine of stpeet anle: <br />� prop,ity Lines • Indicale NoAh <br />• Ou�.�ine and dimensions of all ezisting and � Show any proPosed grading chanSes <br />proVosed structures on Ihe lot � Show measurements <br />• Existing and proposed utilities <br />PERh11T CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 2�J9•88� 5. <br />2, All work shall be performed in accordance with ihis permil and current City of Everet� Design and Conctruclion <br />Slandards and Specifications <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1'EOU'4Z4•55 .:. <br />•• ,� Cadc.�Ers <br />.T,US7AGL /2 ���� <br />ClNDE.E' Zl2�tiEal�if/ i�iaN(� S�oE O� <br />��` ��-- /���� <br />Approved lor Constru ion <br />/ �va�e <br />��/., �-�-F� <br />Da�e <br />FIN 9 C N <br />qpproved as Consiructed <br />everett PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8015 <br />�'U�vE�r <br />iPo.9Du�9f/„ <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicaN hereby agrees to hold and save harm- <br />less the City of Eve:ett Irom any and all claims lor dameAea costs. <br />expenses, or cau5e5 of action that may arise beteuse ol inSlellaUon <br />and maintenance of lhe improvement or olher right•oFway use hereto <br />applied for a�d lurther agrees lo remove same upon notice from Ihe <br />Ciry and lo replace public property dam2ged thereby. <br />� '—"-"-' Date <br />Signature ol Applicant <br />dORD YSTOF� DATE PERMIT SESSUED AND THEREA TER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT O��ER 90 DAYS DURATION. <br />