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Date t £ Public Works Perm;II 0 <br />slap. dept. • Ta.,a�� <br />Application For $$j <br />PUBLIC WORKS PERMIT WlToal ee Fee s t <br />i Less April. Fee PaW • S <br />Print or Type Only <br />{ <br />I g <br />1 / y A..,, 1-JP/a t4 r/k Zdy Lss-�SSS� <br />Cj <br />r <br />is <br />I C3; <br />iLAJ <br />QWn4f <br />Applicant Mailing Address City Zip Phone <br />A , r <br />Describe Proposed Work <br />Project Address fit known) _77e1 SIT /—tte (�4far <br />/-Y.r/`" <br />Attach four (4) copies of plans for proposed work - Draw to scale <br />and note the following as applicable: <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 />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 his. in advance -phone 259.8810. <br />2. All work shell 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 hr& before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />I <br />rett PUBLIC WORKS DEPARTMENT <br />Ever tt, WA Street <br />le Everett, WA 98201 <br />Phone: 259-8810 <br />H <br />N <br />O <br />/D-/6- 618 <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. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />S,gnature of Applicant 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 PURSUFD 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 />