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Date!�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Atldress <br />GYOIiC WO�M{ PlfTi� • �� <br />eiap. Deo�. � <br />PuGI¢ Wprks Fee <br />Totel Fee s <br />Less ADD�- Fee VeiC 5 <br />9�bnce0ue S <br />��� 3o3,o3ys <br />Zip Phone <br />Describe Proposed Work �e��i� � T �u «-D ��� �" �L �� �'�` w � <br />Projecl AdAress (if known) <br />Attach four (4� copiec of plans tor proposed work - Draw to scale antl note ihe lollowing as applicable: <br />• Property Lines • Centerline o1 sireet <br />� Outline and dimensions ol all existing and • Indicale Norih <br />proposed structures on the lot • Show any proposed 9radinfl changes <br />• Eaisting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All cells lor inspection ahall be made 24 hrs. in advence - phone 259•881 O. <br />2. All work shall be peMormed in eccordance with this permit and current City o1 Everett Design and Construction <br />Standarda end Specificatlons. <br />3. Cell Locetior, Underground Service 4B hre. belore you dig. TOLI FREE NUMBER 1•800�424•5555. <br />S'� bc u�L(C � p �' �ilA LC L/ <br />� <br />�� 8��� Dc�G P�R,�� i r� <br />: L.o GlTE> <br />4-� 08 O <br />�9�9� <br />Approved lor C� on i • ume <br />� <br />FINAL INSPECTION Date <br />ppproved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />,1 • 1J <br />u <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Gty ot Everett Irom any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because of installation <br />and maintenance ot the improvement or other right•o4wqy use hereto <br />applied for and further agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />/� � 9 <br />Signature of Applic nt D[e <br />WORK AUTHORIZE'� THIS PERMIT MUST BE STARTED 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 CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />