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Date ���'��,���> � <br />� <br />Application For <br />PU[3L.IC WOR6CS PERMlT <br />Print or Type Only <br />Owner <br />.-� <br />Applicant <br />Mailing Address <br />Describe Proposed Work �� ������� �)�� �� �`���� F���� )� <br />Project Address (it known) <br />Pub'�c A'loik- Pornn� �+ j <br />oiai Dco'-= � � � ' I <br />Puhlit Works Fcc S <br />Tolal F2e <br />Less ApO� Feo Pald S <br />Balance Duo $ <br />Attach four (4) copies ol plans for proposed work - Draw to scale and nole the tollowing as applicable: <br />• Property Lines . Y Centedine of slreet <br />• Oulline and dimensions of all existing and • Indicate North <br />proposed structures on the lot e Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />I. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with ihis permit and current Cily of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� '���"��. <br />Approved for Construction <br />�'f '��.��fG 1.l_`'C`�t��'��� ��l��C-I�11J�� <br />�- i <br />Date <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everetl, WA 98201 <br />Phone:259-8875 <br />4 i�_ i,' �� ' 1 � E�l._ ( <br />�� <br />7/�g 7 <br />( <br />AGKNOWL[DGFMGNT OF CONDITIONS <br />%� <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees �o hold and save harm- <br />less !he City of Everett from any and all claims (or damages, costs, <br />expenses, or causes of action that may arise because ol installalion <br />and mainlenance of ihe improvement or other righhohway use hereto <br />applied lor and further agrees to remove same upnn notice irom the <br />CiIY and to replace public properry damaged thereby. <br />Signature of ApplicaN Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. �HIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PAOJECT OVER 90 DAYS DURATION. <br />