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�• <br />�. "I I.11 � I <br />� <br />Application For <br />PUBLIC VYORKS PERMIT <br />F'rint or Type Only <br />rviaiiing naoress <br />Uescribe Proposed Work �TY�➢"C/�� � � - <br />Project Address lif known) <br />� <br />� P�Dbc Works Perm� • <br />I BIOp DeDI. � ���,- <br />up <br />Attech low (4) copies of plans lor proposed work • Draw to scale and note Ihe Idf(owing as a,�plicable: <br />• Propeity Lines <br />• Outline and dimensions of all e::�sting and <br />propnsed structures on Ihe lot <br />• Ezi[ting and {�roposed utilities <br />Pub1¢ Work� Fce <br />Tolai Fee s <br />Less ApOL Poc PeiE s <br />Balance0ue S _ <br />• Centerline of street <br />• Indicale Plorih <br />• Show any prouosed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All r.alls for Inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall ba perlormed in accordance with this Fermit end current City of Everett Design and Construction <br />Stendards and Specifications. <br />3. Call Location Underground Service 49 hrs. betore y��u dig. TOLL FREE NUMBER 1•800-424•5555. <br />Approved lor Cons;ruclion <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMEtJT <br />� 3200 Cedar Street <br />Ereret4 W49B201 <br />Phone: 259�8810 <br />I��T" ���J I i2� <br />• -.; <br />. <br />ACKNOWL�DGEMcNT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />H <br />N <br />Q <br />a <br />The undervigned owner/apPlicant hereby agrees to hold and save harm� <br />-- less the City ol Everetl Irom any and all claims for damages, costs, <br />expenses, or causes o� ac�ion ihat may arise beCause of installation <br />and maintenance of the improvemenl or other riphl-obway use hereto <br />applied lor and lurther agrees to remove same upon notice irom the <br />Date City and to replace public properry damaged thereby. <br />Datc _ <br />Signature of Applicant Date <br />WORK AUTHO!i!�ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEfitvllT IS ISSUED AND THEREAFTER IS TO <br />�E DILIGENiLY PURSUED TO COMPLETIOM. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORY. ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />