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Date_ �$�% <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />naamng naaress <br />� <br />c�iy <br />Describe P�oposed Work n('Jq/ � � nalP 'hsiu� �✓ �(�y� <br />� <br />Prole�t Addiess (if known� <br />Lip <br />Attach lom (al copies ol plans for proposed work • Draw to scaia and note Ihe lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all ezisting and <br />proposed siructures on the lot <br />• Existing and proposed utilities <br />i <br />/7 .� <br />Public WorhS PUrmil +///��� v/ �� <br />Bltlp Dept � �_���� __ <br />Pubhc \VarFg Fce <br />TatnlFee s _ <br />Lessln�LFecPaia s <br />�alanceUuc S �� <br />• Centerline ot street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hrs. in advance - phone 259-8810. <br />2. All work shall be perto�med in sccordance with this permit and current City of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />`��� �iva�z 2 —/S�-� 9 <br />Approved fo� Cons ion ' De�e <br />— �" G!J-r/� /�- �-�j' <br />FINAL INSPECTION Date <br />Approved as Constructe�t <br />everett PUBLICWORKSDEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />�none:259�8810 <br />�ne <br />ACKNOWIEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City of Everetl irom an� and all claims for damages, costs. <br />expenses, or causes ii aclion that may arise hecause of insta�lation <br />and maintenance ol the improvemenl or r.ther right�ohway use hereto <br />applied lor 2�d I�rlher agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />� <br />ignalur ol AppU an Date <br />WORK �UTHORIZED BY THIS PERMIT MUST BE S ART D WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />