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Date I!I- �`ir`'� <br />Application For <br />r�UBLIC WORKS PERMIT <br />PriM or Type Only <br />�' � � <br />i � <br />� ��c�� )� (�. ,�'`�UI /n,, ���� +., <br />, ...__. Mail�ng Address �J <br />Address <br />� . �� - <br />� Desci�be Proposed Work <br />� Project Address (if known) <br />Zip <br />Puolic woike oe�mG . �/ — <br />B�pq Deot � _.�/ J i �/ %tt _ �_ <br />Pu�li�: worb fea s <br />Tolnl Fea <br />Lam PoO� Foe PUE S <br />Bal;mce Uue S <br />Attach four {4) copies of plans lor proposed work - U�?w to scale and nole � CQo1;erline of stpee� able: <br />• Property I.ines • Intlicate North <br />• Outline and dimensions of all ezisting and � Show any proposed grading changes <br />'� proposed structures on the lot � Show measurements <br />• Existing and proposed utilities <br />Nnone <br />pERMIT CONDITIONS <br />� 1. All calls for insDection shtll be made 24 hrs. in advance - phone 259•88� 5. <br />'� p. All wcrY shall be performeo in accordance with this permil and current City of E•+erett Design and Construction <br />Standara., and Specilicetion.. <br />3. Call Location Underground Service 48 hrs. betore ycu dig. TOLL FREE NUMBER 1-800•424-5555. <br />/ '7 r)e/� <br />{'i✓ �' � <br />�/r <br />� G�� � - ,���� <br />��� � <br />��B � �� / <br />, <br />�� j Ji,/�v,�, <br />�:��fl� <br />Construction <br />FINAL INSPECTION <br />ApUroved as Ccnstrucled <br />everett PUBLIC WORKF �EPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 982Q7 <br />Phone�.^59�8815 <br />Date <br />Date <br />ACKNOWIEDGEM[NT OF CONDITIONS <br />The undersigned owner/apPlicant hereby agrees to hold and save harm� <br />less �he City ol Everett Irom any and all claims lor damages, cosis, <br />expenses, or causes ol action that may arise because of installation <br />and maintenance of the improv=ment or othei righbof�way use herelo <br />applied br and furiher agrees to remove same upon notice from lhe <br />Cily and to repiac^_ puUlic property damagea thereby. <br />Signature of Applicant Date , <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAT[ PERMIT IS ISSUED AND THflREAFTER IS TO I <br />BE DII.IGENTLY PURSUED ?O COMPLETION. THIS PERMIT MAY BE <br />Cl�NCFLLED 8Y?HE CITV UPON ANY STOPPAGF OF WORK ON TIi15 <br />PROJECT OVER 90 DAYS DURATION. <br />