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Date `�� �`—' � '� <br />Applicalion For <br />�l1BLIC W�R6GS PERNiIl' <br />Frint or Type Only <br />Owner <br />Address <br />ity <br />Pubhc Wods Pot �� l . <br />_ ) <br />GItl9 Oept. r _ L!) <br />- --- _ <br />Publm WOMs Fce <br />iotN Fce 5 _. _—__. <br />Less Ap01 Fr,e Vai� $ ___ <br />LnlancC DuC $ <br />�l7 l��f' <br />Phone <br />� <br />��I��(��� C�r�2�. �t� 1.1,� 12� ��i�'-� ' �_� ,��M1�- <br />Applieant Mailmg Adtlress City Zip Phone <br />Descnbe Proposed Work <br />Project Address �il knownl <br />Attach four 141 copies of plar,c for proposetl work - Draw to scale antl note the tollowing as applicabie� <br />• Property Lines <br />• Outline and dimensions of all ex�sting and <br />proposetl strucWres on ihe lot <br />• Existing and proposed utilitics <br />Approved lor <br />• Genterline ol street <br />• Indicate North <br />• Show any proposed gradin9 ,:�ianges <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Localion Undergrcund Service 48 hrs. bcfore you diy. TOLL FREE NUMBER 1•800•424-5555. <br />��� � ���. � <br />� <br />, <br />ion <br />_' /� <br />� / 8� <br />Date <br />FINAL INSPEGTIOPi Da�e <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 9A201 <br />Phone:259-8810 <br />�CKNOVJLEDGE7dENi OF CONDITYONS <br />� <br />� <br />� <br />� <br />� <br />O <br />� <br />�i hn undcrsigned ov:ner/apPlic:in� hereby agrees to ho�d and sove hann� <br />less the City ol Evere�t Irom any and all claims fo� clamages, cosis, <br />eapenses. or causes o! ad�on ihat may arise because of installation <br />and maintenance of the improvemenl or other righ�-of�way use hcreto <br />applied tor and furiher agrees to remove same upon notice Irom the <br />City and to replace public property damaged lhereLy. <br />Siynaiure o� AppliCan� Date <br />Vb'ORK AUTfiORIZED BY THIS PERMIT MU�T BE STARTED WITHIN <br />180 DAYS OF DATE �'ERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIUGENTLY PURSUED TO COMPLETION. THIS PER611T 'dAY B[ <br />CANGELLED BY TFiE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />