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� <br />Date� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />v�ni,c wo,we r�,mn . �'"� •j � ? G -• <br />Bidp �en� � � <br />Pu�Lc WorMs Fee 7 J" (V <br />Tolel Fne 8 ---�— <br />/ <br />Lev �pal Fnn P�iE � � �� -- <br />! �� <br />0llp�Cfl OJ! i � � <br />Owner Meiling Address City Zip Phone <br />Zip <br />Describa Pioposed Work <br />Pro�ect Address pl known) <br />.-., - `� .� <br />Attach four (4) copies o1 Dlena lor proposed work � Draw to scele and note Ihe lollowing as aupliceble: <br />• P�operly Llnes <br />• Outline and dimensions ol all exlsting end <br />proposed slructures on Ihe lot <br />• Existing and pioposed utilitles <br />• Centerllne ol streel <br />• Indicete Norih <br />• Show eny pr�posed greding chanqes <br />• Show measurements <br />�� �il-a E o � ��ff �c-j <br />�� <br />PERMIT CONDITIONS <br />1. All cells lor Inspecllon shell 6e made 24 hrs. In advance � phone 259•88i 5. <br />2. All work shell be perlormed m accoidance with Ihis permit and current City of Everolt Design end Construction <br />Stendards end Specilicetlons. <br />3. Cnll Locatlon Undoryround Servir,e 48 hre. balore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�� � ��� � ��✓�. ��� ��. „ 1� r /< � �/�.� <br />�� <br />�' <br />�l�ll,I(T��� <br />FINAL INSpECTION <br />Approved as Conatructad `� <br />pyp�p�� PJBLIC WORKS DEPARTMENT <br />� 3200 Ceder Slreet <br />Everel�, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The unAersigned ownar/eppllcent hereby egrees to hold and sevo herm� <br />less the City ol Everett Iram eny xnd ell clelms lor demeges, cosls. <br />eMpenses, or causes ol ac�ion thet may erise beceuse ol inelelletion <br />nnd meinlenence ol Ihe improvemen� or other righ��ol�way uee harelu <br />applied for nnd iwthor eB�ees lo remova same upon no�lce irom ihe <br />Glty end lo replece public property dameged thereby. <br />��.. �. / ^/� /_�.i <br />WORK AUTHORIZED BY THISiP1�RMIT MUSi HE STARTED WITHIN <br />180 DAVS OF DATE PERMI{�I� ISSUED �iND THEREAFTER IS TO <br />BE DILIGENTLY PURSUE� TO COMPLE?ION, THIS PERMIT MAY BE <br />CANCELLED Bl' THE CITV UPON ANV STOPPAGE OF WOFK ON THIS <br />PRO.IECT OVFR 90 DAVS OURATION. <br />