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Date_�q%��� <br />Application Foi <br />PU�LIC WORKS <br />Print or Type Only <br />PERMIT <br />Pu01¢ WOrk6 Pp�mi� v �� <br />Bitl9 Dept + _ <br />Pulihc Wo�ks Fce <br />TOldl F�P 5 <br />1P55 A001 FPC Pdip .S. <br />�� <br />o:,�,���� o�� s �� — <br />rn:,�On:; AhtlreSs <br />Describe Proposed Work <br />Project Address (if known! <br />CifV <br />Attach f0ur (�) coPies of Plans b� Proposed work � Dra�c to cr.al:• ,�n� nate ih,a fotla.wnq �s anolicaMe: <br />• P�onerry Lines <br />• Outline and dimensions of all existing ann <br />proposed structures on the lo� <br />• Existing and proposed utilities <br />�� <br />• Ceninrilne ot �tree� <br />• Icdir.ab_ Narih <br />• Sho�a any r,�reposed 3rading r.hanges <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and cu« ent City o( Everelt Design and Consiruction <br />Stanr�:,rds and Specifications. <br />3. CaU ���cation Underground Service 48 hrs. before you dig. TOLL FREE NUMBFR 1-$00-Q2Q-5555. <br />flC�A22 Ca �L�--.Ra-2C� ,SC�[V4XAL <br />1�0>zS?h.ccS c ra^J QC� r/i L�c� . <br />/ <br />FINAL INSPECTION <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Strez� <br />Evere�t, WA 98201 <br />Phone: 259-8810 <br />4U-Q, � .�/u� <br />ACKNOWLECGEMENT OF CONDITIONS <br />7 <br />W <br />� <br />��w <br />= / <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersianed owner/apphcant hcreby agrees to hold and save harm� <br />� I�ss the City of Everett Irom any and all claims lor dama9es, cosls. <br />i expense;. or causes �f action that ma� anse because ol installation <br />! Bnd main�enanr.e o! ihP u»provemen� or olher righ�-ol�way use here�o <br />. I a,^,plir.0 lor nd furiher aqrees t0 remove samc upor no�ice hom �he <br />j Gh' ni,' � iepl:�ca p�bhc proner;y u�:�aaged Ihereby. <br />Sign, tUe ol Applicant ' - ` �� / Da�e <br />WORK bAUTHORIZED BY THIS PERh11T �dUST BE STARTc'.D WITHIN <br />780 DAYS OF DATE PERMITIS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERId1T IdAY BE <br />CANCEI.LtD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />