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Date_� �' '% <br />i <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Describe Proposed lNork <br />Project Address (if known) <br />City <br />PuDlic Works Permi� • <br />Bltlg, OePI. • .�_ % %� <br />� <br />PUEI¢ WarMs Fao <br />Tolnl Fea $ <br />Less Ap01. Foe Paitl 5 <br />Balance Duc $ <br />�hone <br />Attach (our (4) copies of plans (or p�oposed work • Uraw to ecale and note the following aSapplicable: <br />• Property Lires • Cen(erline ot sL•eet <br />• Outline and dimensions of all existiny and • Indicaie North <br />proposed s:ructures on the lot • Show any proposed grading cSanges <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONOITlOIJS <br />1. All calls for inspection shall ue made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />5tandards and Specifications. <br />3. i;all Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/��/'�/c �i�s f�F,e�-iiT .�Uor .�ry,�,k�0 <br />Ar;,roved for Construction Dale <br />FINAL INSPECTION Date <br />i���proved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />32U0 Cedar Street <br />� Everett, WA 98201 <br />� � Phone: 259-8815 <br />/ ,3'O�a'7 <br />. <br />i <br />���, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to hold arid save harm� <br />less the City of Everett rrom zny and all claims tor damages, costs, <br />expenses, or causes of action that may arise because ot installation <br />and maintenance of Ihe improvement or other righPohway use hereto <br />apPlied for and further agrees to remove same upon notice from the <br />City and to replare public property damaged ihereby. <br />Signature of App��cant Dale <br />WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMITIS ISSUED AND THEqEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS P[FM�T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />