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Da!e_�f� <br />npplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describe Pi�posed Wcrk <br />Prolecl Address (if known) <br />Pu01¢ Woda Permi� • <br />BItlB. �oPl. � ��_— <br />PublicwmreFee S <br />Total Fo� <br />Lcaf AOP�� FOe PaiO § <br />Oalanca Duo <br />ty Zip ' <br />�c�2. Chn�,Qd� S;'vel <br />clC�_4 <br />Att�ch four (4) copies ol plans lor proposed work - Drew to scale and note the lollowing as applicable: <br />• Pr„oerty Lines • Centerline of streel <br />• Outline and dimensions of all existing and • Indicate North <br />proposed slructures on the lot • Show any proposed grading ch.anges <br />� Existing and proposed utilities • Show measurements <br />PERI�AIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall 6e pedormed in accordance wilh this permit and current Ciry of Everett Design and Construction <br />Standards and Specitica(ions. <br />3. Call Locatlo� Underground Service 48 hrs. before you dig. TOLL FREE NUNiBER 1-800-424-5555. <br />33 7-oia� <br />ne <br />i�U�-� C�-z.�� i���r�r/� ,���� _ <br />� -� `�� <br />���� <br />Approved lor Construction <br />FINAL INSPECTION Date <br />Approved as Constructed <br />eve�e[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everott, WA 9d201 <br />Phone: 259�8810 <br />ACKNOINLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />•' <br />♦ <br />� <br />0 <br />F- <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby a�rees to hold and save harm� <br />less the City o� Everett Irom any and all claims for damages, cosls, <br />expenses, or causes ol action that may arise because of inslallation <br />and �naintenance of ihe improvemenl or o�her right-oFway use herelo <br />ap�� ied for and further a9rees to remove same upon notice Iwm the <br />C+iy a�d to replace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE ST�RTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVFR 90 DAYS DURATION. <br />