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Date_ ��/ � � /�� <br />! Application For <br />PUBLIC WORKS PERMIT <br />Prfnt or Type Only <br />Puoi¢ Warx� Perm _ <br />B�Op �ept • / � <br />PUEI¢ Work� Fae <br />Tot�IFee : <br />Le�� �p0< <e� P�iU a <br />B�I�nc� Uue i <br />— / 7 Y�--� <br />Ci�y Zip <br />Applicanl Meiling Address City Zip Phona <br />Deecribe Proposed Work <br />Project Addreas (il known) <br />� a'�d ����ti., � <br />Allach four (4) copies ol plens lor proposed work • Oraw to acale and nole the lollow�ng as applicable: <br />• Property Lines • Centerline ol street <br />� OuUine and dimensions of all exisling and • Indicate Norfh <br />proposed structures on the lot � Show any p�oposed grading changes <br />• Existing end proposed utllities • Show measurements <br />FEFMIT CONDITIONS <br />1. All calls for Inspectlon shell be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall ba perlormed in accordence with this permit end curren� City ot Everett Design and Conslruction <br />Standards and Spacificetions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER �•8�0•424•$5brJ. <br />� `GJ�{:f.S � y'�'- /'/> >. , .Z�OT � � y'liik'l✓% <br />Approvetl lor ConSVut�ion <br />FINAL INSPECTION <br />Approved ns Consiructed <br />eve�ett PUBLIC WORKS DEPARTMENi <br />� 3200 Cedar Siree� <br />EveretL WA 9B201 <br />Phona:259-A815 <br />// C <br />� ;�'� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />Thc undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Ciry ol Everett liom any end all claims lor dameges, cosls, <br />eMperses, or ceuses of aclion thal may urise because ol installation <br />and mamtenence of ihe impiovement or other righl�ol�way use hereto <br />applied lor and further agrees lo remove same upon notice �rom Ihe <br />Ciry and to replace public property damaged iherehy. <br />Signeture of Aoplicant Dale <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PEfiMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON TNIS <br />PROJECT OVER 90 DAVS DURATION. <br />