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<br />�pplicalinn For
<br />PUBLIC WORKS PERMIT
<br />Print or Type Only
<br />Owner
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<br />H��p Qi aj �� Mai�'ing Address City Zip Phone
<br />Descri6c Proposed Work ��i�i � r'� ��YI:�L-��l- �� �� � ��N —�--
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<br />Prolect Address lif knownl .
<br />Attach four I41 copies ol plans for proposed worrc - Drav: to scale and nc�e Ihe following as applicable:
<br />• Prr,perty Lines • Centerline of siree�
<br />• Outhne and dimensi0ns of all ex�stin9 and • Ind�cate Nat�h
<br />pron��rd siruc�ures on the lot • Show any pruposed g�adin9 chanyes
<br />0 Eaistmg and pr000sed uhlities • Shoci ineasuremenis
<br />PERMIT CONDITIONS
<br />t. All calls for inspectien shall be made 24 hrs. in advance - phone 259•8810.
<br />2. �II work shall be peAormetl in accordance with ihis penit and current City of Everett Desic�n and Construction
<br />Standards and Specilications.
<br />2. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555.
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<br />ACKNOWLEDGEMENT OF CONDITIONS
<br />! �� .� _ The undersic�ned owner/applicanl hereUy agrees to hold and save harm�
<br />�� " r �� less ihe Cily o� Everetl Irom any and all claims for dama9es, costs.
<br />�; 2"�('(a>: �fi� �z- =����'t «���•`{•L expenses. or causes of actio�� �hat may arise because of installntior�
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<br />t'� and maintenance ol ihe improvement or olher �igh4ol-way use nereto
<br />% f^. ---�-� ��'--'��� y%� �ppLed �or m�d furiher a<jrees to remuve same upon no�ice �rom Ihc
<br />Appro��nslryclion �; �) � �� e Ci1y and to replace Pubhc pioperry damaged therehy.
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<br />FINAL INSPECTION � D:�1�•
<br />Hpproved as CcnsVucted Si9nalu e o� ApplicaM
<br />WORK AU1HO:1iZGD BY THIS PERMff MUST BE START[D WI�I!IPl
<br />i.��.����� PUBLICWORKSDEPARTMENT 180 DAYS OF OATc PERMIT IS ISSUED AND THEi7EAFTER IS i0
<br />� 32UOCeda�Street gE D�LIGENTLY PUF���1ED TO COMPLETION. THIS PERt.1IT 1.9AY B[
<br />Everetl, VJA 98:01 CANC[LL[D Bl' THE CITY UPON �NY STOPPAGE OF WORK ON �fll5
<br />Phone: 259-F3810 PROJECT OA�ER 90 DA�'S DURATION.
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