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tr <br />Dat�2. �' �� �� � <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Meiling Address <br />Describe Proposed Work 1v�UJ ,�,r 1 CJF�G� <br />Projecl Address (it known) <br />Attach lour (4) copies of plans for p�oposed work • Draw to <br />• Properry lines <br />• Outline and dimenslons of all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />PENMIT CONDITIONS <br />PUDI1c Work�Pennit • ��pz � <br />BICO-UeOLk g3���— <br />Puelie Worke Fee ^� O O� <br />7o1a1 Fee s <br />Lees ApD� Fee Pa1E S <br />� o� <br />Belence Due S � <br />Phone <br />up rnone <br />notc Iha !o„owing as applicable: <br />�� Cenfedice of street <br />• I��dicatrt North <br />• ShoH• any proposed grading changes <br />• Show measurements <br />1. All cal's for inspection shall be made 24 hra in advance • phone 259•881 5. <br />2. All work Lha�l be perlormed in accordance with thia parmit and current Ciry of Everett Design and Construction <br />Standards o�d Specifications. <br />3. Call Location U�derground Scrvice J8 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />fINAL INSPEGTION <br />Approved as Consiructed <br />everett <br />e <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evere;t, WA 98201 <br />Phene: 259-8815 <br />ACKNOWLEDGEMENT OF CONUITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />a <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims for damages costs, <br />^,..:enses, or causes ol acfion ihat may arise beceuse o( inslaitation <br />and maintenance ot the improvement or other right•of-way use hereto <br />applied �or and furlher agrees to remove same upon notice 1;om fhe <br />Ciry and to replace pubiic propeiiy damaged lhereby. <br />Signature of ApPlicanl v �� Datc <br />WORK AUTHORIZED BY THIS PERMIT MUST'3E STARTEU WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND ?HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS � <br />PROJECT OVER 90 DAYS DURATION. <br />1� <br />� ' <br />r � <br />� <br />r <br />