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� oe�es��y <br />Application For <br />PUB�IC WORKS PERIVIIT <br />Print or Type Only <br />PUEIie WOA� Pa mil • �� <br />Blap. Dept t ��� �J /,�[ <br />--`_'i— <br />P�CIi� Works Fee <br />Totsl Fee S <br />Less AppL Fee PeiO S <br />Bal�n�e Due S <br />– � riwne <br />Describa Proposed Work <br />ProJect Add�ess (il known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note ihe tollowing as applicable: <br />� Pioperty Lines • Centerline ol street <br />• Outline antl dimensions of ail existing and • Indicate Nor�h <br />Proposed structures on Ihe lot • Show any proposed gracling changes <br />• Existing and proposed utili�ies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made :4 hrs. in advance - phone 259-881 5. <br />2. All work shall be pertormed in accordance with this permit and current City of Evereq De�ign and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�� <br />1 N�� I�•� �N o 2K S 0`Pr .�..1 d—' <br />�pS- u � .Z r� <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBIIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, 1Nq gg2p1 <br />Phone:259-8875 <br />` y� bc�be!o�,,.._ <br />6-�_�% <br />u� <br />■ � <br />�� <br />v� <br />� <br />C) <br />�+ <br />♦ <br />ACKNqWLEDGEMENT OF CON��TIONS <br />The undersiyned owner/applicant hereby agrees to hold and sa��e harm- <br />less Ihe Cily ol Everult Irom any and all claims for de��e3e;, costs, <br />expenses, or causes ol action that may arise because c' 4r,tallation <br />and maintenance of Ihe improvemeN or other right•ol•way use herelo <br />applied lor and further agrees to remove same upon nolice Irom Ihe <br />City and to replace public properry damaged Ihereby. <br />Siflnature of Applican� Date <br />WORK AUTHORIZED BY TH�S PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFiMl7 IS ISSUED AND THEREAFI�ER IS TO <br />BE DIUGENTLV PURSUED TO COMPLE710N. THIS PERMIT MAV BE <br />CANCELLED 8Y THE CITY UPON ANY STOPPqGE OF WORK ON TIiIS <br />PROJECT OVER 50 DAYS DURATION. <br />� <br />�t <br />� <br />