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� '� .-. <br /> �ate PUUIic Wods Permit <br /> Applicalion For �I�p.Dept� _�_���� <br /> �—_.. <br /> PUBLIC WARKS PER11lIIT P°°°°W°��SFCe -- <br /> To�alFee 5— <br /> LessFppl F�:ePaiJ $ <br /> Print or Type Only e,,�.,�,��o„�, s _ <br /> l n � i�� r�l� <br /> Owner Mailing Aduress City 7_ip Phone <br /> Applicant Mailing Address City Zip Phore <br /> Describe Propos=d Work � � ` -� 1 �I�L1���( . � �� (�l i <br /> W <br /> Prolect Address�if known) _ � <br /> Attach four(4)copies ot plans for proposed work� Draw to scqle and note Ihe lollowing as ap cable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions ol all existiny and • Indicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existin9 and proposed utilities • Show measuremeNs � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.AII calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All�.vork shall be pertormed in accordance wilh ihis permit and current City ot Everett Design and Construction <br /> Standards anA Specifications. <br /> 3.Cal1 Location Underground Servica 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � � <br /> �2c i ��� . . O <br /> ������i/r.i � ' <br /> �/� -�� � � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDII"IONS <br /> The undersi9ned owner/applican[hereby agrees to hold and save harrn- <br /> — less the City of Everelt from any and all claims for damages, costs, <br /> expenses. or causes of action that may arise because ot installation <br /> and maintenance of Ihe improvement or other righFof-way use hereto <br /> applied lor and fwther agrees �o remove same upon notice Irom the <br /> Approved lor Construction G�te City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature ol Applicact Date <br /> lev� PUBLICWORKSDEPARTMENT WORK AUfHORIZED BY THIS PEAMIT MUST BE STARTED WI7HIN <br /> � 3200CedaiStreet 180 DAYS OF DATE PERt�11T IS 13SUED AND THEREAFTER IS 70 <br /> Everett,WA�J8201 BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> � Phane:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />