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Appllcxtlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />�so� ii �v� s_t'. <br />Mailing Address <br />I��UUG <br />Mailing Address <br />Deecrl6B PropOsed Work �U iti.� I� /1GR /1�/•O Ri <br />Prtlect Address (II known) <br />Zip <br />Cily 21p <br />Pu�llc Worb Parmll • 2 <br />B�Ey Dep1. � �� SJ �3 <br />PUEI¢Wort�Fen ` <br />Talel Fee <br />Lee� �Oo� Fee Feid f <br />B�I�nce D�e i <br />Attach lour (4) copiea ol plene lur proposed work - Draw to ecale end note the lollowing es appllceble: � <br />• Property llnes • Centerline of slreet <br />• Outilne and Clmenslons of ell exisling end • Indicate Nnrih <br />proposed ntructurea on tha lot • Show any propased B�ading changes <br />• ExlstinB end proposod utilitlas • Show maeauremenls <br />PERMIT CONDITIONS <br />1. All cells lor Inapeclion ehall be made 24 hrs. In ad�•ance � phone ZS9•88i S. <br />2. All work ehall be perlormed In accordenr,e wOh thls perml� and current City ol Everett Deaign end ConsVuctlon <br />Stentlerda end Specilicetions. <br />3. Cell Locetlon Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 7•800•424•5555. <br />�/D �UB�iG !f/o�,�s ��,ir <br />Approved lor Conshuclion <br />FINAL INSPECTION <br />ApproveJ es Consiructed <br />rverett PUBLIC WORKS DEPARTMEN7 <br />� .12�0 (�i0d9f $�fB9� <br />Everet�, WA 98201 <br />Phone:259�8815 <br />Date <br />Date <br />�'����,�.o <br />��'1-�.�s� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownar/applicenl hereby agrees to hold and aeve herm- <br />less the Cily ol Evnretl irom eny end ell claims lor demepes, coat4 <br />ezpenses, or ceuses ol or,lion Ihat may erlae because ol Instelletlon <br />and meintenence ol the imp�ovement ar ather righ4of-wey use hereto <br />epplied for and fuithar ngrees to remove seme upon notice Irom the <br />Cily end to replace publi�: properry damaged thereby. <br />Signature ol ApPlicant Date <br />WORK A'1THORIZED BV THI.S' PEHMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />8E DILIGENTLV PURSUED TO COMPLETION. Tf11S PERMIT MAV BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />