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Dete <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1'ubb< WoiAn Parmn � — <br />Blne Deo� � <br />Puoi¢ wo�ks iee s <br />Totnl Fee <br />Less Apt�L Fee Paia S <br />Balrnce Oue S <br />Mailing <br />�� <br />DescdDe Proposed Work _.—.:.�� <br />Prolect Address lil known) <br />Attech lour (4) copies of plans lor proposed work - Draw to scale and note t�e following as applicable: <br />• P�operty Lines <br />• Outline and dimensions of all existing and <br />proposed strucWres on the lot <br />• Existing antl proposed ulilit�es <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />i�aaaa <br />PERMIT CONDITIONS <br />1. All calls lor inspeclion shall De made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pe�lormad in accordance with this permit and current City of Everett Design and Construction <br />Standarda and Specifications. <br />3. Call Locetion Underground Service 49 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />p,� LA�eGE R�FC6�TnRS <br />� FLAS�I'uC� BARRICAnc51 AT C.-fTN�cR C�VO oF DuFtPS��C <br />(JE�yrt vAc-�o MA�CH 17 Tt1�u�c,N hIA��+� !�1 <br />�,� _�-,/ :�-1C-- �0 <br />Approved for nstruCtion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar Sireet <br />Everett. WA 98207 <br />Phane: 259�8810 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City o� Everett irom any and all claims for damages, wsis. <br />expenses. or causes ot ac�ion that may arise because of installation <br />and maintenance ot the improvement or other right-of-way use herelo <br />applied lor and turthei agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />i ;i � <br />�7%�..0� , i /"�.7 <br />Signalure Applicant� i Date <br />WORK 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 BG <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEC � OVER 90 DAYS DURATION. <br />