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Date�7 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Oniy <br />P ��Iic Wo�ks Po�ml�i .•� � �Q�/�/y <br />PEO� Deo� � �—/—{—i= ^•7Y <br />/ <br />Fuohc worxe Foo S, <br />Total Fea <br />Lesa AoO� Fea hitl $ <br />Balunta �uo <br />Describe Proposed Work <br />Proiect Address (if known) <br />Attach lour (4) copies of plans lor proposed work - Draa <br />• Property Lines <br />• Outline and dimensions ot all existing entl <br />propased structures on the lot <br />• Existing and proposed utilities <br />scale and note the IQ�lbwing as applica6le: <br />• Cemerlino ol street <br />• Indicate North <br />O Show any proposetl grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All call5lor Inspection shall be made 24 hrs in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with ihis permit and currenl City of Everett Desiqn and Construction <br />Standards and Specillcations <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />fUjG iC C�-��/',�s' %�c,�..�ir .a/�� ij�E��c<-�Fo <br />Approved lor Const�uc�ion <br />.�/'S�/97 <br />��.� <br />ACKNOWLEDGEMEWT OF CONDIT:ONS <br />1 � <br />� <br />Z <br />� <br />Thc undersignetl ovmer/applicant hereby agrees to hold and save harm- <br />Iess the Cdy ol Everett Irom any and all claims lor damages, cosis, <br />ezpenses. or causes ot action that may anse because of installation <br />antl maintenance ol the improvement or other ri9hFOFway use hereto <br />apphed for and lurther agrees to remove same upon notice irom the <br />Dale CitY antl lo replace public pwperly dar,�getl ihe�eby. <br />PINAL INSPECTION Date <br />Approvod as Construcled <br />evere[t PUBLIC WORKS �EPARTMENT <br />� 3200 Cedar Slreet <br />Everett. WA 98201 <br />Phone: 259-881 5 <br />Sic�nature ol Appl�cant Date <br />WORK AUTHORIZED �Y THIS PE`7M1T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP 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 />