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Date_)WIA3 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />S <br />Project Address (if known) <br />City <br />Zip <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />Public Works Permit e '1 J 52- 7 <br />Bldg. Dept. e <br />Public Works Fee ` <br />Total Fee <br />Less Appl Fee Paid = <br />Balance Due <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />0 Show any proposed grading changes <br />0 Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 him in advance - phone 259-M 0. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 him before you dig. TOLL FREE NUMBER 14300.424-55M. <br />rvIoLu bG TZXGG Seaver moOn * WztbW Mt0.:2S ty, Are, it <br />4. 'it-A�16 I Av%44 p ;�_/i el I on e, ko W, done- fr r <br />drA\V-'lq subM:ktcd by <br />AppP for Cons r tioDate <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMEN'i <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />R Za "rr' . <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 claims for damages, costa <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use he;ato <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />WOFtf AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY ThE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />