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Date����� <br />/�. <br />AppliCa�iOn FOr <br />PUBLIC VI/ORKS PERMIT <br />Print or Type Only <br />rublicwork.Purm + � <br />BICB. Dopl. r �� <br />PubliC Woik9 Fee 5 <br />Tolal Fca <br />LcSs A001. Fco PaiE S <br />BalanceDuo $ <br />Applicant <br />Describe r'roposed Work <br />Project Address (if known) <br />Address <br />Ciry <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note Ihe following as <br />• Property Lines <br />• Outline and dimensions oF all existing and <br />proposed strucWres on ihe lot <br />• Exisling and proposed utililies <br />PERMIT COND�TIONS <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />1. All calls for inspection shall 6e made 24 hrs. in advance • phone 259-881 5. <br />2. All work shall be perlormed in accordance with this permit and current City of Everett Design and C�nstruction <br />Standards and S�ecitications. <br />3. Call Location Unaerground Service 48 hrs. b�lore you dig. TOLL FREE NUMBER 1-800•424-5555. <br />i�v/���G Cvo,2,�c r�,G,e��T �or �PEa����a <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees' � hold and save harm• <br />less the City of Everett from any and all clairc for damages, costs, <br />expenses, or causes of aclion ihat may arise hecause ol installation <br />and maintenance of the improvement or other right-ohway use nereto <br />applied for and further agrees to remove same upon notice trom ihe <br />City and to replace public property damaged lhereby. <br />Signalure of Applicant Date <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 COtiIPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. � <br />