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F��s <br />J <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />It/l�lt 1'I�l <br />i <br />t— <br />Describe Proposed Work <br />Putsk wore Pamll 0 <br />Bldg Deyl. <br />Total FN <br />Lau spot Fit POW i <br />B'sarce Out <br />,3Y5- 73u 7 <br />y psj i, 6 <br />o.J f00 ^,o <br />Project Address lit known) <br />d work - Draw to scale and note the following as applicable: <br />Attach lour 141 copies of plans for propose <br />• Properly Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centeillne of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrsin advance - phone 259.8815. <br />2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications, 555. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1.800.424.555 `d^ <br />Date <br />A rived or CO uclio <br />Date <br />FINAL INSPECTION <br />Approves as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8815 <br />Z <br />r� <br />K <br />FM <br />_I H F <br />a, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi,innd owner/applicant hereby agrees to hold and save harm. <br />less the Cdy of Everett from any and all claims for dcmages. costs. <br />expenses. or causes of action that they arise because of Installellin <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agreeeseto removedamaged thesame reby <br />notice from the <br />City and to replace p P P Y <br />Signs of fltPncent <br />r <br />WOR UTHORIZED PY THIS PERMIT MUST BE SIMnTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PHOJECT OVER 90 DAYS DURATION. <br />r� <br />