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Date`��Ev /J <br />Application For <br />PlJBLIG V�/OF�KS PEP�Mi'T <br />Prirt or Type Only <br />/ <br />ng Address <br />ir I <br />f1;6, <br />� <br />%" ��� �,1� <br />y Zip <br />� Zip <br />�i ��i <br />�/�y. <br />Punli< Wa�ka Fermit • _'._ <br />BIJp. Dapt + _ ___._d_ <br />ruenc wq�u F - <br />ro��ci�a��,;,. _ <br />��5la A001 iee Paitl S __. <br />Balnnce Oue a _ <br />� ` ' ��+f ��. <br />'%��Js/ ' �.�'3�C,o <br />Phone <br />Phona <br />Describe Proposed `Nork ��� -� � ' .`"�� ` '/---�- � � <br />�/ f it A.PF � /✓��d��� ��17 �i'r7i � �'i ��- /!% /�•-!j� � — <br />% �� <br />Project P.ddress (if known) <br />Attach four (4) copies ot plans for proposed work • Draw to scale and note ihe follorring as applicable: <br />• Property Lines • Certerline of street <br />! Outline and dimensions of all existing ar d • InAicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and propcseC utilitias • Show measuremenis <br />PERMIT CONDIT�ONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be performed in accordance with Ihis permit ann current Ciry o� Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground 5ervice 46 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />FIN.�L INSPECTION � <br />Appr�ved as Cunstruded \ <br />everett PUBLIC WORK <br />� 3200 CzdarSveet <br />Everelt. WA 98201 <br />Phone:259-8815 <br />( •���- <br />, <br />J—�� <br />ate <br />,� " — � �'��� , <br />Date <br />� ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cily of Everett irom any and all claims lor dama9es, costs, <br />expenses, or causes ot action that may arise because of installation <br />and maintenance of the improvement or othei right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />$ignature ol AP�`anl v°'c <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />t80 DAYS OF DATE PE(;MIT IS ISSUED AND THEREAFTER IS TU <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PaOJECT OVER 50 DFYS DURATION. <br />