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Date�.it_t� (7 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Zip <br />PUDbc Wmks Perm�l • �� —�� <br />eiaa o,oi • �� <br />Pueec workf ree <br />Tolel Fee s — <br />Leae �pa�� Fee PaiO $ �Q�— <br />Dalanca Oue S �� <br />Desc�ibe Proposea Work _ �u � –�— <br />Pro�ect Address (it knownl <br />0 <br />AttaCh four (4) copies ol plans for proposed work • Draw to scale and note ihe lollowing as applicable: <br />• Propa�ty Lines • Cente��ine ol street <br />• Ou�line and dimensions ol all existing and • Indicate Nor�h <br />proposed siructures on Ihe lot • Show any prop�seJ grading c�anges <br />• Existing and propused utilities • Show measurr,merits <br />rnone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All worF shell be pedormeo m accordance with :his permit and current City ol Everett Design and Construction <br />Stendarda and Specilicat�ons. <br />3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />� <br />Date <br />Approved as Construcled l 1 (, <br />�J <br />everett PUBLIC WOiiKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Evemtt,�WA �J02G1 <br />Phone:259-OB10 <br />ACNNOWLEDGEMEWi OF f,ONDSIONS <br />W <br />� <br />O <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicanl hereby a9rees N hold and save ha�m� <br />less the Ciry ot Everelt irom eny and all claims for damages, costs, <br />expenses, or cau5es ot action ihat may arise because ol installation <br />and main�enence ol the improvoment or oth�;r righbobway use hereto <br />applied for and fuither agrees lo remove same upon notice irom Ihe <br />Ciry an replaco publicyr�perty dameged thereby. <br />i.��,_ /� " � _ � ' .P � <br />Signa�ure ol Applic�n� Dale <br />N'ORK AUTHOHIZED BY �HIS PERIAIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTER IS TO <br />BE DILIGENTLY PUNSUED TO COMPLETION. THIS PEiiMIT MAY BE <br />CANCELI.ED BY THE CITY UPON AN'f STOPPAGE OF WORK ON THI' <br />PROJECT OVEFi 90 DAYS DURATION. , <br />