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Date4�a C' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ma ling Aaaress <br />Describe Propo:ied Work <br />Project Address (if known) <br />City <br />0 <br />Public works Permll ♦ Bldg �epl s _61/ ILO[G <br />Public Yolks Fee <br />TWOFee <br />Less App- Fee Paid S <br />Balance e.,e $ <br />!41/5 SS)--oZC(i5 <br />Zip Phone <br />Zip Phone <br />Attach. four (4) copies of plans for proposed work - Draw to scale 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 propusec' grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />LI <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. <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 />r3��c was �s,T ,voT .c�q�.ieEo <br />S///B.6 <br />�a� <br />for Construction <br />Dale <br />FINAL INSPECI ION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 9i 201 <br />Phone: 259-8815 <br />M <br />0 <br />n <br />[z <br />r/ <br />ch <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />tess 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 />Signature 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 PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURArION. <br />