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Date-Iq 8� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r <br />Public Works Permits _. <br />Bldp. Dept. A, Q�z �7 <br />Public Works Fee § <br />Total Fee <br />Less ApPL Fee Paid S <br />Balance Due S <br />Zip <br />6fd 5C-2:92194/ <br />Zip Phone' <br />Describe Proposed Work f P vY n, I - 1 !36 r7 <br />LU <br />Project Address (if known) � � -S f <br />Attach four (4( copies of plans for proposed work •Draw to scale and note the following as applicable: <br />� <br />• Property Lines • Centerline of street <br />,^ <br />• Outline and dimensions of all existing and • Indicate North <br />�6 <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />O <br />1. All calls for inspection shall be made 24 hm 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 />z <br />�a8c c cva s ��i�rnrrT �✓oT ��q�,PE� y-/�( a 7 <br />0 <br />i am <br />Approved for Construction <br />FINAL INSPECTION Date <br />Approved as Constructed <br />n <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of actior 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 DURATION. <br />