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; _ _. <br />. � �B�B.�= � <br />" t qpplicatl�:�. For <br />i PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />PuOLc Work� Permi� <br />BiEp. Depl. s <br />PUEIic Wark� Fee s <br />Totel Fae <br />leas AoO� Fee PaiA S <br />Bnlance Due S <br />Deacribe ProFoged Work <br />Proiect Address (if known) <br />Addtess <br />y� <br />Zip <br />- s4�-ia�. <br />Attech fnur (4) copies of plens for proposed work • Draw to scale and note the tollowing as applicabW. <br />• Property Linea • Centerline of street <br />• Outline and dimenaions of ell existing and � Show any p oposed grading changes <br />prOpoaed atructures on the lot <br />� Exi8Ung and Droposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection ahell be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be parformed in accordance with this permit and curtent City of Everett Design and Construction <br />Standarda end Specificetions. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FtiEE NUMBEFII •800�4245555. <br />�o/fi�ln.%Uziz.� �Qrr1",.`.i�/�%�.C�e�c��2e� <br />C��"" "" _ �idtT''�— <br />� , '�ZJ - �� <br />` Approved for Construction Date <br />FINAL INSPECTION Date <br />: Approved as Constructed <br />; �PUBLIC WORKS DEPARTMENT <br />3200 CedarStreat <br />Everett, WA 88201 <br />Phone: 258•8810 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all laims tor damages, costs, <br />expenses, or causes of action that may erise because of installation <br />and maintenance of ihe improvement or other right•of•way use hereto <br />applied for and turther agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY TYIS PERMIT MUST BE Sl'ARTED WITHIN <br />780 DAYS OF DATE PERMiT iS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PUFSUED T7 COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />