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Date�� 7 <br />AppliCation For <br />PUBLI� WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describe ProposeA Work <br />Project Address (ii known) <br />Ciry <br />City <br />Publlc Worke P^�mlt t v�/G � <br />BIEp Dept. ♦ <br />PuEllt Workt Fee <br />Tolel f4e S - <br />Les� AVGI Fee Pe�E S Q <br />Belance0ue S-�Sa <br />Attach four (4) copies of plans lor proposed work • Draw to scale and note Ihe following as applicable: <br />• Property Lines .• Centerline o( street <br />• Outline and dimensions ol all exisling and • Indicate North <br />proposed structures on Ihe lot • Show any proposed gradin8 changes <br />� Ezisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with this permil and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />j� To BE Co.vSri��icrE'� i�:� �I,o.�,�u✓E<� f��9�✓S <br />v9TFo �-z9-�s� <br />Approvea wr i.onniucuun // <br />�-.�.�/ � !f� <br />FINAL I PECTION � <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 96201 ,."� <br />Phone: 259-8�+�'+ �v8'ut� <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages, costs, <br />expenses, or causes of aclion that may arise because ol installation <br />and maintenance of the improvement or other rigM-ohway usn hereto <br />npplied for and lur her agrees to remove same upon notice from ihe <br />City and to epl� pu lic prope ly damaged thereby. <br />� <br />`, <br />;- Q- t,Lp �� <br />5ignat re ot Ap ant Date <br />WORK AUTHORI2E0 BY THIS PERMIT MUSi BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TNiS PER1.11T A4AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />