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Date_S.�L�sL � <br />qpplication For <br />PU�LIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describe Proposed Work <br />Project Address (if known) <br />�f�� <br />Address <br />Address <br />� <br />iPu�lic Worka Permit a <br />Bldp. D¢Ot. • <br />Public Works Foe $ <br />Total Fee <br />Less AonL Fee Pai� � <br />Balance Oua $ <br />�ip niuru <br />Attach four �4) copies ot plans for proposed work - Draw to scale and note the following as appu�oie: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed structures on the lot 4 Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenis <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 pedormed in accordance with this pennit and current Ciry of Everetl Design and Conslruction <br />Standerds and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•S00•424-5555. <br />NOl" R ��C-� ,�/a�� <br />� <br />Approved forConsiruction <br />FINAL INS?ECTION Dale <br />Approved as Con,trucled <br />everztt PUBLIC WORKS DEPARTMEN.T <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259-A810 <br />ACKNOWLEDGEMENT OF C(1NDITIUNS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undrrsigned owner/applicant hereby agrces to hold and save harm- <br />less ihe City ol Everett Irom any and all claims lor damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvemenl or other right-of-way use hereto <br />applied for and furlher agrees to remove same upon nolice from the <br />City and to replace public property damaged lhereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERM�T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />