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Date1LL_C7_O� <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />2 <br />Applfcent <br />Describe Proposed Work � �p�, �I � (� ¢i <br />Projett Address (if known) <br />i� <br />PublicWorksParmi � I <br />emy. oeo�. • ��� <br />PUEIIc Worhs Fex <br />Tolel Feb x <br />leaf AOP�- Fee PsiE i <br />8sisnce Due t <br />Phone <br />up rnone <br />Atlsch four (4� copiea of plans for proposed work • Draw to scele and note the lollowing as applicable: <br />� Property Lines • Centerl���e ol street <br />• Outline and dimensions o( ail er.isting and � Indic��te Norih <br />proposed structures on the lot • Shuw any proposed giading changes <br />• Ezlntiny end proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calle for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design end Constructlon <br />Standarda and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•SS55. <br />�l� �'1'121 t �-� ��I i�� ���- <br />C=��� <br />Approved tor Construction <br />FINAL INSPECTION <br />Approved es Constructed <br />everett FUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar S�reet <br />Everett, WA 88201 <br />Phone:259-8B1G <br />Date <br />Uate <br />ACKNOWLFDGEMENT OF CONDI'fIONS <br />W <br />H <br />� <br />� <br />The undersigned nwner/apDlicent hereby agrees to hold and save harm- <br />less ihe City of Everett from any and all claims for demages, cosis, <br />exaenses, or causes of action that may erise br,cause of instaltation <br />and maintenance of the improvement or other ri6ht�of-way use hereto <br />applied fo! aqd furt r agri•es to remove same upon notice irom the <br />Cit� and to .pla p ic propert damaged there5y. <br />� <br />r 'ls / - ,� -F <br />� nature ol Applicant D te <br />1VORK AUTHORIZED 8Y THIS PE MIT MUST CiE STpfiTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br />BE DILIGEtJTLY PUPSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRQJECT OVER 90 DAYS DURATION, <br />