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� <br />Date� � I <br />'"'_� <br />Applicalion For <br />PUBLIiC W`C�RKS PERMIT <br />Print or Type Only <br />Pu�LCVlorksPor i a ���/''q��' j <br />eina o�ai., _� �`_L�BLdp <br />PubLCWorksFce 5 <br />TotN Fce <br />Lass Appl Fec Paia 5 <br />Oalnnr.c Duc $ <br />lt •�t <br />Applicant Mailing Address City Lp Phone <br />Describe Proposed Wurk <br />Pro�ect Address lif known� <br />Attach lour (4) copies ol plans for proposed work � Draw to scale and n`ot�the following as applicable: <br />• Property Lines • Cen�erline of street <br />• Outline and dimensions ol all existing and • Indica�e Norih <br />proposed struclures onthelot • Show any proposed �rading changes <br />• Existing and proposed utilities o Show measurements <br />IS L <br />PERMIT CONDITIONS <br />i. All calls tor inspection shall be made 24 hrs, in advance - phone 259•8810. <br />2. All work shall be pertormed in ar.cordance with this permit and current City of Everell Design and Construction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. hefore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Approved lor Construclion <br />r��-� �c� . <br />-i� �I�� ���. <br />��,-�-�� <br />` <br />Date <br />FINAL INSPECTION �ate <br />Approved as Consiructed <br />everet[ PUELIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 99:01 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDI"iIONS <br />W <br />H <br />0 <br />� <br />� <br />0 <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City ol Everelt Irom any and all claims for damages, costs. <br />expenses, or causr.s of action that may arise because of installation � <br />and mair'enance ol the improvemenl or other righl-ohway use hereto <br />applied lor and Wilhei agrees �o remove same upon nolice from the <br />City and to replace public property damaged thereby. '�. <br />SignaWre of Applicant Date '�, <br />WOFK AUTHORI�ED BY THIS PERMIT MUST BE STARTED WITHIN i <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M`.Y BE � <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />