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oate ��% �� 1 _��[ - <br />-- -�_ _.,. _ _ _ _-- --- - __ _ ------�--- -. <br />-� <br />Application For <br />F'UBLIC WORKS pERM9T <br />Print or Type Only <br />� <br />U7 'I <br />Adtlress <br />v <br />Pu�lit YJo�hs Pmmil • r' _ <br />eina ocpi. n �i',ll��`J..� /1 _ <br />Pubhc�Yo�M�Fen S <br />Tcml Fm <br />Less FPPL Fce PaW S-- <br />BalancaDu� S <br />Applicant Mailinc� Adtlress City 2ip Phone <br />Ueiscribe Proposed Woik �1- � � ��� � <br />Projec� Address (il known) <br />Attach lour (4) copieS ol plans for P��Posed work � Drav; to scale and note the lollowinq as applicaUle: <br />• Property Lines • CeMerline of slreet <br />• Outline and dimensions of all exisling and • Indicale North <br />proposed structures on ihe lot • Show any propoaed grading chanc,es <br />• Existin9 and proposed utililies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedurrned in acwrdance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800•424•555.`i. <br />;� _. <br />��-r . , r�-; , f - ,r> � � ; ,,- � �. <br />for Construction <br />FINAL INSPEC'ION <br />AnProved as Consiructed <br />everett PUBI IC WORKS DEPARTMENT <br />� 3200 Cedar S�reet <br />EveretL WA 98201 <br />phone:259-BB70 <br />� <br />Date <br />Datr. <br />l" <br />., %-. , _ <br />;�, -_ .� � i� . <br />AGKNOWLEDGEPAENT OF GONDITIONS <br />The undersigned owner/apPlicaid hr.reby agrees to hold anC save harm- <br />less the City of Everett irom any and all claims fer damages. costs. <br />expenses. or causes ol ac�ion that may arise bec�use of installation <br />and maintenance of Ihe improvemenl or o�her right-obway use hereto <br />applied lor and lurlher agrees �o remove same upon notice Irom �he <br />City and �o replace public property damaged there6y. " <br />Signalure of Applicant ua�e <br />WORK AUTHGRIZED BY THIS PERMIT MI�ST BE STARTEC WI'HIN <br />780 DAYS OF DATE PERM17 iS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETIO�:. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPP�GE OF WORK ON THIS <br />PROJECT OVEN 90 DAYS DURATIGN. <br />