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�' <br />Date � <br />,>pplicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />NoRM SC.HJ�L <br />_ 1' . _... _ <br />6�5 25 <br />PUDI¢WonsPermit�l _ �= <br />Blap Oeot � � " <br />PuD�¢ Woeb Fee s <br />To1�l Fee <br />Lua�po�feePniG f <br />w�..,=e0ue : �� <br />z�z.-.��ERyrr ��3 ��3-7`1�L <br />Phone <br />Describe Proposed N'ork <br />�� <br />?rolect Address (if known) <br />Attech four (4) copies of pians fo� D�oposed work - Draw to scale and note� Cenle hne ot slpeet �ble� <br />• Property Lines • Indicate North <br />• Outline end dimenslons of ell existing and � Show any proposed gr-ding cha�ges <br />proposed structures on the lol � Shew measuremenis <br />• Exiatiag and proposed uVlities _ - <br />PERMIT CONDITIONS <br />1. All calls for inspection shall ba made 24 hr�. in advance - Phone 259•8815. <br />2, All work shall he pertOrmed in ecCordence wilh this permit and current City ol Everett Design and Constructiun <br />Stendards end Specilicillons <br />3. Call Location Underground Servi,:e 48 hrs. before you d�g. TOLI FREE NUMBEA 1•800-424•555 . <br />� �Cv��� � -�//J"S <br />/ Date <br />Approved for Consuuction <br />���- �-- <br />oate <br />FINAL INSPECTION <br />Approved as Constructed <br />Oeverett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Fhone:259�8815 <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIOPlS <br />The undersigned ownerlapplicant heieby egrees Ic hold and save harm� <br />less Ihe City of Eveielt irom any and all cleima �or dameges, costa <br />expences, or causes ot action that may arise because ol instellation <br />ard maintenance ol the improvement or olher riyhFof-way use hereto <br />apphed lor and lurlher agrees to remove same upon notir,e Iron �he <br />Ci'y and to replace Public property damaged 1 ereby. <br />.-,� <br />//�.-._ S <br />"u �"'� Dete <br />Signaturc ol ApPlicant <br />V:ORK AUTHORIZED BY THIS ?E.RMIT MUST BE STARTED WITHIN <br />180 Dl�YS OF DATE PERIv11T IS ISSUED AND (HEREAfTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS �'F.RMIT MAY BE <br />PROJECT O'✓6R 90 ]AYS OURATION. STOPPAGE OF N'ORK ON THIS <br />� <br />H <br />� <br />H "~*1 <br />� � <br />�y <br />O� <br />� <br />N <br />� 2 <br />H <br />N <br />�� <br />� y <br />� � <br />. � <br />�a <br />x <br />� <br />� <br />H <br />� <br />