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ibr <br />run <br />�I <br />�ou <br />Date.JCf3L?� <br />OWN 01111 <br />S iyi,licoli,ni foi <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />2 9a - 3 i3.sr <br />Phone <br />Describe Proposed Work <br />Project Address (If known) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance • phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1.800.424.5555. <br />Approved for Construction Dale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everell PUBLIC WORKS DEPARTMENT <br />Everett WA Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />W <br />H <br />W <br />W <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims for damages, costs, <br />expense& or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right•ol•way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY 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 CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />