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Date���'% <br />Appllcation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />.-. <br />� <br />City Zip <br />Describe Proposed Work � u1(� �^� r� �'�n� �q <br />Project Address (if known) <br />Public Works Permr+lt a �y <br />BIdB. OOPt. s T i/�d %�i � <br />PuClic Works Foo S <br />Totil Foo <br />Less ApP� Fee PaIE S <br />Balonto Duo �J <br />Altach four (4) coples o( plans fo� proposed work • Draw to scale and nole the folloviing as applicabte: <br />• Property Lines .• Centerline of street <br />• Oullfne and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exfstlng and proposed ulflitles • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls tor Inspection shall be made 24 hrs in advance - phone 259-8815. <br />2. All work shall be periormed In accordance wUh this permit and current Cily of Everett Design and Construction <br />Standards and SpecificaUons. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />/—Ur3GiC G<lo,e.c'S t�_/-iAh�-T �a� �EC{U�,eEO <br />qpproved 1or Cansiruction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everet[ FUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259•8815 <br />O� 'u�le—p % <br />�� f'�'�'� <br />ACKNOWLEDGEtAENT OF CONDITIONS <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less tho City of Everett Irom any and all claims tor damages, costs, <br />expenses, or causes of action thal may erise because of installation <br />and maintenance of ihe improvement or other dght•of-way use hereto <br />applied (or and (uriher agrees to remove same upon notice irom the <br />City and to repiace public property damaged thereby. <br />Signature ot 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 COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />