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Date � � y, <br />I <br />,�pplication For <br />I�UBLEC'WnRKS P�fiI11�IT <br />Print or Type Only <br />�� � <br />Owner <br />n � <br />Describe Proaosed N�ork �-� � � f'�� <br />Prolact Address (if know:�� <br />$6- S�E7 <br />Pu�LCWoikSPerm'�a / � ��µ r <br />BIQB� Dept. t _ �� <br />P��Olic Woiks Foc <br />Total Foa g . <br />L059Appl.'E>PPlaf � <br />Daiance Oue S a� <br />City 'Lip Phone <br />Giry up rnone <br />E <br />Attach four (4) copiec of plans for proposed work - Draw lo scale and note the followinc� as applicable: <br />• �roperty Lines <br />• Outline and dimeosions of all ��xisting and <br />proposed structures on the lat <br />• Existing and proposed utilities <br />PERMIT CONDITIO�!S <br />• Centerline of sireet <br />• Indicala North <br />• Sliow any proposed grading chan�es <br />• Show meas�remenis <br />1. All calls for ine�pection shall be made 24 hrs. in ndvance - nhone 259•881 5. <br />2. Ail work shall be pertormed in accurdance with Ihis permil and current City of Everett Design and Cunstruction <br />Standards and Spe�ifications. <br />3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUiVIBER 1-800•424•5555. <br />y. C.un,bs � S�w.r�� .�Zw a� :,�.,.-��%v� . <br />� <br />S. U/�Q_ �.�.,t.��W 6�h"^1�c-'^''u'-'�� e,w� <br />\ <br />(� • `Ti,�., c4.rn-��spa�.�.Ts iiw�C3 �1ru� wc.�� <br />, <br />�� <br />� ACKNOWLEDGEMEN7 OF CONDITIOKE <br />�Oi�O-�� <br />FINAL INSPECTiON ' <br />Approved as Constructed � <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Evere�t, WA 98201 <br />Phone:259�8815 <br />S � <br />✓ <br />� <br />� <br />The undersigned owner/applicanl hereby agrees to ho���o and save har-n� <br />less ihe City of Everelt Iron any and all claimc for damages, cos�s, <br />expenses, or ca�ses of action ihat may arise because of insta!lation <br />and maintenan:e of th? improvement or other ri9ht-ohway use hereto <br />applied lor and further agrees to remova same upon notice irom the. <br />Ci�y and to replace public property damaged thereby. <br />��' / n �J(r <br />igr�Wre of �pplican � � Date <br />W�RK AUTHORI E� BY THIS PER IT MUST BE STARTED WITHIN <br />18J DAYS OF D E PERMIT IS ISSUED AND THEREAFTER IS Tq <br />BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF NlORK OM THIS <br />PROJECT OVER 90 DAYS DURATION. <br />