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Date y-2—�? <br />Application For <br />,°UBLIC WORKS PERMIT <br />Print or Type Only <br />manmg <br />Describe Proposed Work <br />Gny <br />,•,�„�,�v,o,�.,,,�,m�, 37-3a9 <br />eiec. ooni. . � 7� / 4-f--� <br />Publlc Wo�hf foa $ <br />Totnl Fu� ! <br />LIt59F[,.�I Gll�f POi(� + a� <br />�aldno. nw� .S <br />Zip Phone <br />Zip Phona <br />Proiect Address (il known) -� � i-� ' <br />At�ach four (4� copies ol plaos lor proposed work - Draw to scale and note Ihe lollowing as aFPlicable: <br />• Property Linas <br />• Outline and dimensions ot all existing and <br />proposBd structures on the lot <br />• Existing antl proposed utilities <br />• Centedine ot street <br />• In]icate North <br />• Show any proposed grading changes <br />• Show mea5uremeMS <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs in advance - phone 259•881 5. <br />2. Ail work shell be perlormed in accoidance with thic permit and current City of Everett Desian and Construction <br />dtandards and Specilications <br />3. Call location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�.f.�STALL l�PivEC�9� ��f,�� �„-y � F,�f��� �-;�ti-a,�.�,� <br />/r3o7 9,v0 S.�c. r�o.v �.3. 7. <br />��`6���_ 9�d%q� <br />Approved lor f,ons�r c� Da�e <br />�O-T- �� <br />FINAL INSPEC710N Date <br />qpproved as Construcled � <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ccdar SVeet <br />Everetl, WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The untlersigned ownerjaUPlican� hereby agrees to hoid and save harm- <br />less the City of Everett Irom any antl alI claims for damages. costs, <br />cxpenses. or causes of action ihat may arise because of installation <br />and maintenance ol the improvemenl or other right-of-way use hereto <br />pplied lor and further agrees to remove same upon nolice irom the <br />Ciry and to replace public property damaped thereby. <br />Signature of Appucant - ��•� <br />WORK AUTHORIZED BY THIS F�RMIT MUST 8E STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />