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Date1S_�� % <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Mailing <br />0%��1 C`^. �1.:' <br />Describe Proposed Work ���1 i��I� 1 I ��"7� f�/��,�'���n /� <br />Pro�ect Add�ess (il known) <br />�'upLc Works Petm� r. <br />eiae.neo�., ��� " <br />Publ4; WorM f ¢e <br />To1el Fea S . <br />Lena AOP� Fee PaiC S <br />Balance Due S <br />Attach luur (4) copies ol pfans lor proposed work • Draw to scale anA note the folloWing as applicable: <br />• Properry Lines �• Cer,terline of street <br />• Outiine and dimens�ons of all existing and t� Indicale Norlh <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDIT�ONS <br />1. AI: calls for inspectlon ahell be made 24 hrs. in advance • phone 259�8815. <br />2. All work shall ba perlormed in accordance with this permit and current Cily ol Everett Design and Construclion <br />Stendards and Specificationa <br />3. Call Locetion Untlerground Service 48 hra before you dig. TOLL FREE NUMB[H 1•800•424•5555. <br />�U/�'L �C CiJc�/�S /��2�ni7' �,,(��U�/��J <br />Approved for Cnnstruction Uate <br />FINAL INSPECTION Date <br />Approvad as Constructed <br />everett PUBLIC WOHKS DEPARTMENT <br />� 32U0 Cedar Streel <br />Everetl, WA �J8207 <br />Phcne:259-8875 <br />ACKNOWLEDGEMENT OF CONDI'fIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the Ciry ol Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because c1 installation <br />and maintenance of lhe improvement or othei right�ol-way use hereto <br />applied lor and �urther agrees to remove same upon notice liom the <br />City and tu replace public property dama;ed thereby. <br />Signalure of Appl�cant Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATF PERA1!7 �5 ISSUED AND THEREAFTEP IS TO <br />BE DILIGEN7LY PURSUEG TO COMPLETION. THIS PFRMIT MAV BE <br />CANCELLED BY THE CITY UPON ANV STCPPAGE OF JJORK ON THIS <br />PROJECT OV[R 90 DAYS DURA710N. <br />