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Date_j�j�y� <br />.� . . <br />Applita�icn For <br />PUE�LIC WOF�KS PERMIT <br />Print or Type Only <br />�� ►v� P <br />Applicant Mailinq Adtlress <br />ary <br />City Z,p <br />Descnbe Proposed Work �� — �d� / <br />A+[3 <br />Proiect Address Iil knownl � ��' z. Z�{' S�Ic�'-� (�ji:> � <br />Attach four 14) copies of plans lor proposed �vork - Draw to scale antl note the following as apphcable: <br />tor <br />FINAL INSPI <br />Approved as <br />eveir�t <br />e <br />• Property Lines <br />• Outhne and dimensions ol all existing and <br />proposed siructures on Ihe lot <br />• Ezlsting and proposed utilities <br />ni,bLCWo�l.averm�t. /��/��cC� v <br />6inq Deo�. • —�J_��,/ �. _ <br />VULt¢WonsFce / <br />,o�.� F�� s _ <br />lessAppl F?e PaW $ <br />�alanreDue $ Z�'� <br />• Centerline ol streel <br />• Indicr,te Nor�h <br />• Show any p�oposed gracing changes <br />• Show mc�euremen�s <br />Phone <br />PEFMIT CONDITIONS <br />i. All calis 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 curren� City ol Everett Design and Consiruciion <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />/ <br />PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Slrecl <br />Everett, WA 98201 <br />Phone:259�8910 <br />(- /�--�'9 <br />D:tc <br />C�-/ 7 � �V <br />Date <br />ACKNOWLEDGEIdENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby ayrees to hold and save harm- <br />less ihe Gly o� Everett Irom any and all claims lor damages. costs. <br />expenses, or causes of action ihat may arise because o: installatlon <br />and maintenance of Ihe Improvement or other right-obway use hereto <br />applied lor and furiher agrees lo remove same upon notice Irom Ihe <br />City and to replace pubhc property damaged ihereby. <br />Z�I/-�`- �'��c-/•1.:.` �- � �= - / �� <br />Signatme of Applicant Date <br />WOfiK AUTHORIZED 8Y THIS PERMIT MUST B[ STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WOAK ON THIS <br />PROJECT GVER 90 DAYS DURATION. <br />