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Uate� �� <br />� ADPliceli0n For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describe Proposed Work <br />Project Adtlress (il known) <br />Puniir, WorFe Parmn • ���" — /�L <br />Oi�p DeO�� • <br />PUUI¢ Wod� Feo s <br />101lIfPE <br />lnSaRppl Faef'xid S <br />0airncr Dur S �—��— <br />zm <br />up rnone <br />Attach lour 14) copies oi plans for proposed wo�k • Draw to scale and note ihn following as applicable: <br />• Property lines <br />• Oulline and dimensions of all exisling and <br />proposed slructures on ihe lot <br />• Ezisting and proposetl utilities <br />• CeMerline of street <br />• Indicate Norlh <br />• Show any proposed gradmg changes <br />• Show :neesurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be mede 24 hrs. in advance � phone 259•8810. <br />2. All worlc shall be peAormed in accordance with this parmit and current City of Everetl Design and Constn�ction <br />Standerds and Specifications. <br />3. Catl locetioo Undergroun0 Service 48 hrs. before you dig. 70LL FREE NUMBER 1•800-424•5555. <br />9 �:� ���/: y h�� �g,g <br />Approved for Constr ion Date <br />� y�y <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everetl. WA 90201 <br />Phonr;-.259-BB10 <br />ACKNOWL[DGE�dENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />Z <br />O, <br />, <br />�'� <br />O� <br />a <br />The undersigned owneqapplicant hereUy agrees to hold and save harm� <br />less �he City of Everett Irom any and all claims lor damages, costs, <br />expenses. or causes ol action Ihat mny arise because of iastallation <br />and maintenance ol the improvement or other righl�of-way use hereto <br />applied lor and lurther agrees lo remove same upon notice irom the <br />Gty and to replace public property damaged IhereSy. <br />� � <br />� ���e.e( �c� "a�l.�� �� l:" �� <br />Signa ure ol Applicant � Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STAFTED WITHIN <br />780 D�VS OF DATE PERMIT IS ISSU[D AND THEREAFTER I� TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 30 DAVS DUFATION. <br />