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`� � <br />Date_�7� <br />Application For <br />��U�LIC WORKS PERMIT <br />Print or Type Only <br />PubLc vlarks Pernut a � <br />c' <br />Olc1g Oepl. + <br />Pubi¢ WorkS Fco S <br />i olal Fee <br />Le55P0oLFeeP.W S <br />Balance Duc 5 �� <br />nt <br />Describe Proposed Work <br />Projed Address Iif knownl <br />Address <br />City Lip rnone <br />Attar.h tour 141 copies of plans for proposed work - Draw to scale and note Ihe following as applicabie�. <br />e Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on Ihe lol <br />• Ex.isting and propose.l utilities <br />• Centerline of street <br />O Indicale Norih <br />• Show any pioposeA gradinq r.hanges <br />Y Show measuremen�s <br />THIS L <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall 6e pertormed in accordance with this permit and current Ciry of Everett Design and Gonstruclion <br />Standards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. be(ore you di9. TOLL FPEE NUMBER 1•800•42 "i-5555. <br />�� s6�.,� �t <br />�219� � ff.9LL / - = � `�/< <br />ic .—. Si9i Dili � 3. � <br />�� � � <br />q,� % n9ch'r � <br />Af�PL�GAn/T /l7rJS% ME�T N/iTt1 Pr/ij'CiG GcJD.c,c�' <br />1i(/•Si�aC.i a,� dc`a2F Do%c�Cf An/f/e�'�"„ O�/ %F/� .C��C'i� e'ui�/ <br />� <br />�-�� ����- �/a�/�� <br />Approved for Co � ruc�ion Date <br />% ��. 3� -� s <br />FINAL INSPECTION Date <br />P,pproced as Constructed <br />everelt PUBLIC WORKS DEPARTMcNT <br />� 3200 Cedar Sireet <br />EveretL WA 98201 <br />Phone:259�8810 <br />�CKNOWLEL�GEIdENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned ownedapplicant hereL-y agrees to hold and savc harm- <br />less the Ci�y ot Everett from any and all claims for dama9es. cosls. <br />ezpenses, or causes of action that may arise 6ecausz of insta!lation <br />and maintenance ot Ihe improvemenl or other righPof-way use hereto <br />appli lor and lurther ag�ees to remove same upon notice irom ihe <br />Ciry an to replace public roperry damaged Ihereby. <br />i � /� ,{1 ,% <br />i <br />lr'r l!.i' � „ ��C!/'U��"�> 9-i7 ��� <br />Sig ature of ApP�� . �� Date <br />WORK AUTHORIf[D BY THIS PERMIT MUST BE STARTED WITHini <br />180 DAYS OF DAiF PERMIT IS ISSUED AND THEREAFTER IS TO <br />�E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />