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Date�.L�(J <br />5 3er z�-4 � /i�+� <br />I PuoLc Wo�ks Pe it • <br />Application For aieg. oeo�. • <br />PUBLIC WORKS PEFiMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Prolect Address (if known) <br />Mailing Address <br />� <br />City Zip <br />Attach tour (4) copies ol plans lor proposPd work - Draw to scale and note the following as applicable: <br />� Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Ezisting �nd proposed utilities <br />Public Worki Fea <br />totelFee s <br />Less Ao�t Fee PaiO �� <br />Balnnce Due S �� <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be pertormed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Specil�cations. <br />3. Cal� Localion Underground Service 43 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />ACKNOWLEDGEMENT OF COND�TIONS <br />W <br />M <br />� <br />� <br />O <br />�� The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because of installation <br />���� �� C��� � �-3 �O and maintenance ol the improvement or other right-ol•way use hereto <br />. applied lor and turther agrees to remove same upon notice Irom the <br />Approved lor Const ion ate Cily and to replace public property damaged there6y. <br />�LN / �o� ,/�j — S'o <br />FINAL INSPECTION Date <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />9(Cnature`I A�dC� / Date <br />WORK AUTHORIZED BY THIS PERM�T AIUST BE STARTED WIIHIN <br />180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLFTION. TH�S PERMIT MAY BC- <br />CANCELLED BY THE CITY UPON ANY b70FPAGE OF WORK ON THIS � <br />PROJECT OVER 90 DAYS DURATION, <br />