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Date_�� � <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />J/ <br />Address <br />Describe Proposed Work <br />� P�b�ic 4Yo�hs Permil • Z 7 <br />� BiagOeot.+�'�...3-J�.. <br />Pebl�c WorFs ice <br />ro�r� F�� g _ <br />Less ApO�� Fee Pai� g <br />Oaian.e Oue S <br />Cay z�r <br />Zip Phone <br />Project Adtlress (il known) 'lyoc —/ �_n�_r i i� r- <br />Attach lour �4) copies ol plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outlina and dimensions of all eaisting and <br />proposetl structures on the lot <br />• Existing and proposed utillties <br />• CeMerline ot slreet <br />• Indica�e North <br />• Show any proposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-881 O. <br />2. All work shall 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 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />/'if�j �/',C�/�7// ti l� % ,(�,EC � <br />/ <br />Approved lor Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•8810 <br />Date <br />ie <br />C�',�l�7@�� <br />l- T�—SJ"% <br />ACKNOWLEDGC-MENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cily ol EvereU from any and all claims for damages, costs, <br />expenses. or causes ol aclion that may arise because ot installation <br />and mainlenance ol the improvement or olher righ��ol-way use hereto <br />applied lor and lurther agrees to remove same upon notice irom ihe <br />City and to replace public property dama9ed ihereby. <br />Signc Wre ol Applicanl Date <br />WOR�: AUTHORI2ED BY THIS PERMIT MUST BE STARTED V/ITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />