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Date^I n�l�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Gnly <br />r+uni�c vlmwx ne� i� V/�,'-1�i? C"l� . <br />�Itl9. Depl.. _��_.. <br />N��,��Wo,�s��a — <br />,o„� F�� s _ _ <br />Less FnPI Fee PniU S—. <br />e,i,�« o�� 5 2� <br />- qpp;{Car�� Mailing Add�ess City Lp Phone <br />Describe f'roposed Work i� �E� % / /��� � _ <br />Project Address (il k iown) <br />Attach four 1�) coU�es ol plans for proposetl work - Draw to scale and note the following ss apPlicahle�. <br />r Prooerry Lines <br />• Outline and dimeusions ol all axisting and <br />proposed structures on the lot <br />• Existiny and proposed utilit�es <br />FINAL INSP <br />Approved as <br />everett <br />� <br />• Centerline of street <br />O Indicale North <br />• � I•ow any proposed gradiny chanyes <br />• Snow rr=_asurements <br />PERMIT CONDITIONS <br />1. All �aalls for inspecfion shall be made 24 hrs. in advarce - phone 259•881 p. <br />2. All wcrk �nall be pedormed in accordr.nce with this permit and current City ol Everett Design and Constuction <br />Standards and Specifications. <br />3. Call Location Underground Serv�ce 48 hrs. before you dig. TOLL FREF NUM6ER 1•tiUO-424•5555. <br />`�. ��:�w�/ <br />C7iic.ch LJR cf <br />/� <br />Const <br />PUBLIC WORKS DEPARTMEIJT <br />3200 Cedar Streel <br />Everelt, WP, 9A201 <br />Phone: ffiS)�8810 <br />Corycnr-� Cu-Q.�.�-c�;� _�,✓ c�tiC'c.,f"i �v, �.�v <br />J`� .�� �7.� 'z,-i«�Ki �' <br />-tlsi% ��c-?10-��� , <br />!' <br />u <br />. <br />�r <br />Jate <br />r.C�NOWLFDGEIv1ENT OF LONDITIONS <br />Tne unders�gned o�meUapplicanl hereby agrees to hold and save harm- <br />less the Ciry ot Everett Irom any and all claims for damages, costs, <br />expenses, or causes ol action iha� may arise because ol install,dion <br />and maintenance o! lhe improvement or other right-obway use tieieto <br />applied for and further agrees to remove same upon notice from the <br />Ciry and to replace public pwpr_rty dama9ed thereby. <br />/ � r /�n�c' <br />Si ature ol Applicant , ��� Date <br />WORK AUl'10RIZED BY HIS PERMIT MUS FlE STARTED WITHIN <br />100 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TF��.� CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />