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Date�� <br />���� <br />Application For <br />PUBLIC WOF�KS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Adtlress (if known) <br />Atldress <br />City <br />Attach fou� (4) coFics of plans for proposetl work - Draw to scale and nole the lollowing as applicable: <br />� Property Lines <br />• Outline and dimensions ol all existing and <br />proposea structures on the lot <br />• Existing and proposed utilities <br />Pupec\4or�sPeimit• V ��/ <br />BICg. DepL + ! � S�� <br />PuoLCWarksFea -- <br />Totnl Fea S <br />Less Ap01. Foe Paid $ ///��� <br />Batancc Due $ �� <br />S� <br />• Centedine ot streel <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />Fhone <br />Phone <br />PEPMIT CONOITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance � phone 259-881 O. <br />2. Ali work shall be peAormed in accordance with thi� permit and current City ol Everett Design an�1 Constructicn <br />Standards and Specificatiors. <br />3. Cnll Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�.�.�i�-/� �h��8a <br />Approved br ConsV ti Date <br />�� B- Y-6�P <br />FINAL IN EC ION Da�a� <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200Cetlar;,heet <br />Evaretl, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicanl hereby a�rees to hold and save harm• <br />less the City ol Everett irom any and all claims lor damages, costs. <br />expenses, or causes ol action that may arise because ol installation <br />and m2intenance of ihe improvemen! or other nghbobway use hereto <br />applied toi and further agrees lo r�move same upon notice from the <br />City d tZr�replace public preperty damaged thereby. <br />� � � � , <br />ature ol ApPliCant Date <br />WORK AUTHORIZED BY THI ERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMI S ISSUED AND 1HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CIT'f UPON ANY STOPPFGE OF WORK ON THIS <br />PR�)JECT OVER 90 DAYS DURATION. <br />