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. _ _ _.---- - — <br />� _ <br />Date_:�� � <br />� � qpplication For <br />PUBLIC WORKS <br />Print or Type Only <br />PERMIT <br />n�amng naaress <br />ng <br />' Pu�l¢ Woike Per��miii� r <br />Bidq. Oept. � ��� <br />Pu���c Worhs fee <br />Totnl Fee S <br />Less Apol. Fee PaiU $ <br />Bamnce Due S <br />DescribeProposedWork %PNan't rM/lfn�lPrf/:a�_ ��uln�J�.�s s#/ <br />r��:7`-- <br />�,; �,t�e,���e > <br />Project Address (il known) <br />Attach four (4; wpies ol plans for proposed work - Draw to scale and note the following as appiicable: <br />• Properry Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate Noith <br />proposed structures on the lot • Show any proposed gradinc� changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All wc,rk shall be performed in accordance with this permit ar.d current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call �ocation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />for Construction <br />�GJ ,�,� No� �� , <br />�'f D"D�/�'r 3 �'� �9� <br />Date <br />FINAI INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAHTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8870 <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hr.reby agrees to hold and save harm- <br />less Ihe City ol Everett irom any and �all claims lor damages, costs. <br />expenses, or causes of action thal may arise because ol installation <br />and mainlenance ot lhe improvement ur other ric�hl-of-way use herc•to <br />applied lor and lurther a9rees to remove same upon notice irom the <br />City and to replace public propeny damaged the�eby. <br />Si�naWre ol Appficant Date <br />'NORK AUTfiORIZED BY 1HIS PERMIT h7U5T BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED A�D THERE.IFTER IS TG <br />E3E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPGN ANY STOPPAGE OF INORK ON THiS <br />PFOJECT O`JER 90 DAYS DUR�TION. <br />. ._. _ _ __.... . _ <br />—. . __. . _.._.. <br />