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Date=LL•� �� <br />Application For <br />f�UBLlC WORI�� PERI'r011T <br />Print or Type Only <br />City <br />Applicant <br />Mailing Address <br />Describe Proposed Wark � ��\��=� -r � � � <br />Project Adtlress (if known) <br />Attach four ;4) copies of plans tor proposed work - Drzw to scale and nole ihe lollowing as <br />• Properry Linea <br />4 Outline and diniensions ot all existing anc <br />proposed siructures on !he lot <br />• Exiatinci antl proposed utilities <br />PubLc Wcrks Permi�� <br />BIOB� Dept • � <br />Pubi¢ Warks Fee g <br />Total Fea <br />les� FpO� Fee PaiA S <br />Batance0ue .0 <br />Zip Phone <br />• Centarline ot sireet <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurer�enls <br />PFRA4IT CO4GITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work ohall be pedormed in accordance �wth this permit and current City ol Everett Design and Cunstruction <br />Standards and Speoifications. <br />3. C311 Location Under�round Sen-ice 48 hrs. before you dig. TOLL FREE NUMBEA 1•S00•424-5555. <br />Approved for Consiruction <br />FINAL INSPtCfION <br />App�oved as Constructed <br />everett PL'BLIC WORKS DEPARTMF.NT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phon�: 25b BB10 <br />� <br />�� 1��!�� L� (1���, <br />, <br />��' y�-"/�' <br />ACKNOWLEDGEMENT Or CONDITIONS <br />J <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/appiicaN I�eret 7 agrees to hold and save harm- <br />— less the Cdy of Everett from any '.nd all Gaims for damages. costs, <br />eapenses, or causes of action that may arise because o( installation <br />and maintenance of �he improvement or other right-of�way use hereto <br />applied lor and further agrees lo remove same upon notice Iroin the <br />Date City and to replace public property damaged thereby. <br />Signature ol AFplicant Date. <br />WORK AUTHORIZED BY THIS PERMIT �1US�f BE STARTED WIl'HIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO CnMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON .iIJ1' STOPPAGE OF N'ORK ON THIS <br />PROJECT OVGR 90 DAYS DURA� 10'1. <br />