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Date_i � Y`�J� <br />Applicali�n For <br />PUBLIC WOR6CS P�RMIT <br />Print or Type Only <br />ruohcWaik;Pum � <br />a��, ���,, , -��` �I I�- <br />Pu�lm Works Fce S <br />Tota1 Fee <br />Less Appl. Fee Paitl $ <br />�alance Oue $ <br />Describe Proposed Vlork <br />Project Address (il known) - <br />Attach four (4) nopies of plans for proposed work - Draw to scale and nole ihe following as <br />• Properly Lines <br />• Outline and dimensior.s of all existing and <br />proposed structures on the lot <br />i Existing and proposed ulililies <br />� Centerline of sireet <br />• Indicate Norlh <br />• Show any proposed grading changes <br />o Show measurements <br />LI <br />PERMIT CONDITIONS <br />7. All calis tor inspection shall be made 24 hrs. in advance - phona 259•881 5. <br />2. All work shall be performed in accordance with this permit and current Ciry ol Everetl Design and Construction <br />Standards and Specifieatlons. <br />3. Call Localion Underground Service 48 hrs. before you di9. TOLL FREE NUMBER 1-B00•4'L�3-5555. <br />,�l�b'G/G GJO�%��S' l`�,�:e�'�i� �t/C�T �PEC1l//�s� <br />ApprOved for Consiruction <br />��� ��7 <br />��� <br />ACKNOWLEDGEMGNT OF CONDITIONS <br />� <br />� <br />The undersi9ned ovmer/applicant hereby agrees to hold and save harm- <br />less the City ol Everett trom any and all claims tor damages, costs, <br />expenses, or causes of action ihat may arise because ol instailation <br />and maintenance of Ihe improvement or other righFcf-way use nereto <br />applied ior and further agrees to remove same upon notice from the <br />Date Cily and to replace public properly damaged thereby. <br />FINAL INSPECTION Date <br />qpproved as Constructed <br />evemlt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett. WA 98201 <br />Phone:259-8815 <br />Sic�nature ot Applicant Date <br />WORK AUTHORIZED BY TNIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERf�tIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOP� E OF �VORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />