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Application For <br />PUELIC WQF�KS PERMIT <br />Print or Type Only <br />Pu�Lc 1Yortt Permil • <br />BIEp Dept � _�yr� � v3 <br />Puobc Wo�kt Fm s <br />TnhlFae <br />��/� �Ool Fee Pe�O S <br />B�bnce0ue f _ <br />(+N1 C. <br />Applicant Mailing Address City 2ip Phone <br />Deacribe Propased Work <br />Pro�ec� Address (il known) <br />�, 9 ,� <br />Aflach four (4) copies o� p�ens for proposed work - Draw to scale and note the following as appliwble: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed StrUCtures on the lot <br />• Ezisting and proposed utilities <br />PERMIT CONOITIONS <br />• Centerfine ol sireet <br />• Intlicate North <br />• Show any proposed grading changes <br />• Show measurements <br />1. All calls lor inspection shall be made 24 hrs. in ativance - phone 259•$$1 E. <br />2. All work shell be perlormed in accordance with this permit and current Ciry ol Eve�e;t Desi�n antl Consiruction <br />Standards and Speciflcations. <br />3. Call Location Underground Senice a8 hrs. belore you dig. TOLL FREE NUMBER 1•800-424-5555. <br />/ /� 6/�� <br />/��iJ <br />�Pi.., , � <br />�j O.c/<> /"� <br />/' %u�i��X <br />��„G�%�+^ <br />C <br />(o—`�'F� <br />ACKNOWLt.^. ;EMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />�w <br />_ I <br />O <br />a <br />The undersigned owner/applicanl hmeby a�rues to holA and save harm� <br />less ihe Ciry ot Everett Iwm any and all claims lor tlamages, costs, <br />expenses, or causes of action that may arise because ol mstallation <br />antl maintenance ol the improveme��t or other nght�obway use hereto <br />Approved lor Construchon applietl lor and lurther agrees to remove same upon notice Irom the <br />Date City and to replace nublic nroperty tlamaged thereby. <br />FINAL INSPEC710N Date <br />Approved as Constructetl Signature ol Applicanl Date <br />everett I'UBLIC WORKS �EPARTMENT WORK AUTHORIZED OY THIS PERMIT MUST BE STARTED WITHIN <br />� 3200CedarSireet 1B0 DAVS OF DATB PERM1IIT IS ISSUED AND TNEREAFTER IS TO <br />EveretL �NA 98201 B[ DILIGENTLV PUNSUED TO COh1PLETION. 71115 PEfiMIT 1.;AV B[ <br />F'honc 259-8815 CANCELLED DV TNF CITY i1PON nNl' STOPPAGP OF IVOqK ON THIS <br />PiaOJECi� OVER 50 DhYS DURATION <br />G' <br />� <br />� <br />� <br />� r. <br />H� <br />Ul `. <br />� C_ <br />C[+1 � <br />� F <br />.� ; <br />�� <br />�; <br />�: <br />�y� <br />K! <br />O <br />� <br />�. <br />Y< . <br />ii ' <br />c <br />F�. <br />r . <br />