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��������q <br />ApPlicatien Fur <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Matlin� <br />City, <br />�- <br />�'unim \Yorws P�r i . ��lJ ___ _ <br />��no ocoi . _����..3 �✓�f/_.. _. . <br />Am Wm�s Fee <br />ioia� Fce $ <br />lr5s Appl F.n Pm0 5_ <br />e, ��:,,�� ,. n,,. „ Z cJ =� —. <br />Descnh � proposed 1Nork PLI/ i��r_ —�ry f-3 ___— <br />Pwlect Address �il known) z � �(�. � <br />Attach four �4� copies of plans lor proposed work � Oraw to scale and note Ihe followinc� as appllcable: <br />• Property Lines <br />• OutGne and dimensions ol all existing and <br />proposr.d struclures an the lot <br />• Existing and proposed utilities <br />• Cenlerline ol streel <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Shov: measurements <br />.�c — <br />Phone <br />PEAM�T CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advancr • phone 259•8810. <br />2. All work shall be peAormed In �ccordance wi�h this permit and current Cily of Everett Design and Conslruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800•424-5555. <br />� '-� � �LG �J�� <br />Ap o e.b lor C� (��CliO� Date <br />—��/�`� ��� c�' / j - `i a <br />FINAL IN�PFC710N Date <br />Approved as Constructed <br />evcren PCBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everell WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />■ <br />� <br />O <br />a <br />The under,igned ownerlapplicant hereby agrees to hold �nd save harm- <br />less the Gty ol Everetl Irom any :�nU all claims for damac�es, costs, <br />expenses. or causes ol action that may anse because ol instrJlation <br />and maintenance ol the improvemenl or other right�ol�way use heretc <br />applied for and lurther agrees to remuve same upon notice Irom Ihe <br />City and ro replace public propmty damaged thereby. <br />7� /I%.C� �-3� - �J'u <br />Signatme of Apphcanl Date <br />WORK AUTNORIZED BY TIi1S PERMIT MUST BE 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 />CANCELLED OY THE CITY UPON ANV STOPPAGE OF WORK OK THIS <br />PROJECT OVER 90 DAYS DURATION. <br />