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Date��. <br />Application For <br />PUBL.I�C Vi/ORKS PERMI� <br />Print or Type Only <br />h <br />Describe Proposed Work <br />/ I.�Pubhc lVorNs Pn�mil v —_ — _ <br />�inn oco�.. ._��7-�i2_�'�-- - <br />Pubiic Wo�hs Fce S <br />To�nl Fce <br />Less AnO� Fee PmJ S <br />Ipnlance Ouc � _ <br />�t-rd (� `1 ��-� <br />Zip � Phone <br />� ��d� �5� <br />Zip Phone <br />Prolect Address (il knownl - `r`���"�/J`""""'�"" <br />Atlach tour (4) cop�es of plans for proposed work - Graw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposetl struclures on the lot <br />• Existing and proposed utilities <br />• Centerline ol street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in acwrdance with this permit and current Ciry of Everetl Design and Conslruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�7 G ! � I�IJ(%2�/�Y �1n7�� � I/C� ��*��j�L.�G2(?PO <br />0 <br />for Construction <br />Date <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />a <br />N <br />� <br />O <br />r <br />N <br />O <br />a <br />The undersigned owner/apPlicant hereby agrees to hold and save harm� <br />less �he Cily ol Everett Irom any and all cl�ims for damages, cosis. <br />expenses. or causes of aclion that may arise because ol installation <br />and maintenance of Ihe improvement or olher righl•ol�way use herelo <br />applied fcr and lurther agrees lo remove same upon notice from Ihe <br />Ciry and to replace public property dama�ed lhereby. <br />Sic�nature ol Applicanl """ <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. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />