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�.�� �/-�; /�� <br />Date i "�.�1 �� <br />AOpIiC��iOfi Yor <br />PUBLIC V�/ORKS PERMIT <br />Print or Type Only <br />ifi� n �f' <br />Applican� <br />Describe Proposed Work <br />Project Address �il knownl <br />Mailinc� <br />i A- i <br />U'I <br />City <br />R:ULc �yorxs Pr�}(�?^�'� <br />B'�g Depl. < V LJ���_. _ _ �. <br />1 <br />PubM1c Wwks Fce � <br />ir��nl Fec S _ <br />_�:;sAp0l.FepPaid $ __ <br />P.nMncn Ovc .i <br />Z�P Phone <br />��p Phone <br />Atlach lour (4) copies of plans for proposed work - Draw lo scale and note ihe following as applicahle: <br />• Property Lines • Cen�erline of ��reet <br />• Outline and dimensions of all ezisting and • Indicate Norih <br />proposed slrudures on Ihe Io1 e Show any nroposed grading changes <br />• Existing and proposed utilities • Show nieasurements <br />PERMIT CONDITIONS <br />1. All calla for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and curreni City of Everett Design and ronstruction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. 6efore you dig TOLL FREE NUMBER 1-800•424•5555. <br />Approved lo� Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />everen PU6UC WORI(5 DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone:259�8810 <br />r�+- � �� . <br />,�� <br />ACKfJOWLEDG[MENT OF CONDIT!ONS <br />Z <br />O <br />The undersigned oa�nedapplicant hereby;,grees to hold and save h;um- <br />— i less ihe City of Everett Irom any and all claims for damagas. costs. <br />expenses, or causes of action that may arise because ol ins�allation <br />and main�enance of thr. improvement or other right�ol-way use herelo <br />❑oplled for ,ind lurthei ngrE-.,s to remove same upon nohce frorn Ihe <br />Date � Ci�Y onrl to iepl, ce puhhr p��,p�rty tlam�9ed �hc�eby. <br />Date <br />Si�in.ilurr, of ApPhc:int —�— D�(n � <br />WORR AUTHORIZED CiY THIS PERA4IT MUST BE S1�Af7TED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COtvIPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURAI"ION. <br />