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. . <br />� . - .�._ � . <br />Application Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe Proyosed Work <br />Pro)ecl Addrese (II known) <br />�r <br />PuMic Wmke Permil • <br />Biep Deo� . � � — iGa,c� <br />?ueLc WorM� Iea <br />Totei Fee s <br />Lef�ApO� FeeP��a s _ <br />9�I�nce Due <br />Atlach four �4� coples ol plana lor propoaed wo�k � Draw to scale and note the lollowing as applicable: <br />• ProOerty Lines <br />• Outline and dimensiona ol all existing end <br />proposed afructures on the lot <br />• Existing end p�oposed utilities <br />PERMIT CONDITIONS <br />• Centerline ol sireet <br />• Indicale Norih <br />• Show any proposed grading chenges <br />• Show measurements <br />1. All calls for inspection ehell ba maCe 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with ihis permit and current Cily ol Everett Design and Consiruclion <br />Standards end Specificetiona <br />3. Call Locatlon Underground Service 48 hra. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�D �/s3l_/C- �'✓'cl,E�tS' �c--� <br />� r�iT <br />ApP�oved lor Conslructian Date <br />,1'F=Gt �i�Q <br />3�.3"i-8 � <br />�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />0 <br />a <br />The undersic�ned owneqapplicant hereby agrees to hold and save harm� <br />less ihe City ot Everelt from any and all claims lor OemeBes. cosls, <br />expenses, or causes ol aclion that may arise because ol insinllation <br />and main�enance of the improvemen� or other righPo4wey use here�o <br />applied lor and further a�rees to remove same upon notice from t�e <br />C�ty and to rep'ace publlc property damaged thereby. <br />FINAL INSPECTION Date �i <br />ApD�oved as Constructed Signature cl Applicanl Oate � <br />everel[ PUBIIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITNIN � <br />� 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND TIIERLAFTER IS TO <br />Everett. WA 98201 BE DILIGFNTLY PURSUED TO CO�dPLETION. THIS PERMIT MAV BE <br />Phone�. �59�8A15 CANCELI ED BV THE CITY UPON ANY STOPPAGE JF WORK ON TNIS <br />PROJECT OVER 90 DAYS DURATION <br />