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Date�2/ '� <br />� <br />Application For <br />�t��l_IC WORKS PERMI� <br />Print or Type Only <br />�a Ma e - -- <br />Applicant �.la�ling Addre:s <br />C�Iy <br />Y�1 <br />� lu�l¢ Wo�ks Pc�met • '_ <br />smo.oeo�.+ - <br />Puei¢ W orFs Fee <br />Tolal Fee g _ <br />Less A0�! Fee Paia u <br />Balanca0ue �'! <br />7 7�_ <br />�[ � � ' <br />De&cribe ProPa�ed Work .��Jn>r�r�.�� vH Ai+ /� /✓t��i�������_ ��_ <br />Project Address (if known) <br />4ttach four (4) copies pf plans lor proposetl work - Draw to scale and note ihe following es applicable: <br />Y Property Line�s <br />• Ou�line and climensions of all exis�ing and <br />proposed stniclures on the lot <br />• Existing anA nroposed ulilities <br />• Centerline of sireet <br />• Indicalr, North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIO�dS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City ol Everett Desiyn and Construction <br />Standards and Specilica�ions. <br />3. Call �ocation Underground Service 46 hrs. bebre you di�. TOLL FREE NUMBER 1•$00•424-555$. <br />Approved tor Construction <br />FINAL INSNECTIOtJ <br />Approved as ConslructeA <br />evrmU PUBLICWOF.KSDEPARTMENT <br />3200 Cedar Streel <br />Everetl, WA 9B20t <br />�V Phone:259-8810 <br />3�-�� <br />��� <br />, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />7 I <br />� <br />0 <br />The undersi9neA owner/apPlicant hereby agrees to hold and save harm- <br />— less thr. City of Everetl irom any and all claims lor tlamages. cosis, <br />ex�enses, or causes of action that may arise because ot insfallation <br />and maintenance of ihe improvemenl or other ric�ht-of�way use hereto <br />applied tor and further ayrees to remove same upon nolice Irom ihe <br />Date City and to replace public property damaged thereby. <br />Date <br />re ol P.pphcant <br />Date <br />WORK AI:THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 1'O <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERPAIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOFPAGE OF WORK ON THIS <br />FROJECT OVER 90 DHYS DURATION. <br />