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Date��_li�� � <br />� <br />Application Por <br />PUSL.IC WOR�(5 PERMIT <br />Frint or Type O�ly <br />. � I 1 <br />��l 1 � � h�F� �� -� <br />Owner <br />Applicant <br />Describe Proposed Work <br />Prclect Add�ess (if known) <br />Mailing <br />� <br />�,�,�,� :,a-�s �,.,,,,� . <br />��' , <br />mn.� o�ci . —,L��. . _ .-1. J� C) <br />PuLI¢ Wo�Vs fca <br />To�ai Fee 5 -- <br />Less Appl Fee Paa S_ <br />(�,�lanu� Oue $ _ <br />7_�p Phone <br />Mailing Address Ci�y Zip Fhone <br />A[tach low (41 copies ol plans for proposed we�k - Draw to scale and note <br />• Property LineS <br />O Gutline and dimensions ol all exi;ting and <br />prcposed siructures on Ihe lot <br />• Esisting and p�oposed utilities <br />lowing as auPlicable� <br />• Centerline of slreel <br />• Indicate Nonh <br />f Show any proposeC gradinc� changes <br />• Show measurements <br />PER�71T GONDITIONS <br />1. All ca�is lor inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All wcrh snall be peAormed in accordance with �his permi� and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service CB hrs. before yoc dig. TOLL FHEE NUMBER �-800-424-5555. <br />Approvad for ConSlruGtion <br />FINAL INSPEGTION <br />Approved as Constructed <br />everett PUBLIC' � 7RKS DEPARTMENT <br />� :;200 Cedar Street <br />Everett. WA 9�3201 <br />Phone:259-R81J <br />� -��;�-- '��'C_7 , <br />C i�"'"" �ioa� <br />� /8 -.� 9 <br />ACKf.IONJLEDGEMENT OF CONDITIONS <br />� <br />0 <br />The untlersi�ned owner/apPlican� hereby agrees to hotd and save harm- <br />less Ihi� Gty of Everett (rom any 2na all claims for damages, costs. <br />eape�ses. or causes of action that may arise because ol installation <br />and maintenance or Ihe improvement or other right-ol-�.vay use herele <br />applied for and lurther agrees to remove same upon notice from 'h= <br />Date City and to replaca public property damaged ihereby. <br />Signalwe ol Applicant Datc <br />WORK AUTHORIZED BY THIS PERAIIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSU[U AND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PEFMI� MAY 8E <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />FROJECT OVEP, 90 DAYS DURATION. <br />