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Date�-'� -.Pl <br />Application For <br />PUBLIC WORKS PEFiMIT <br />Print or Type Only <br />Wb1ic Workf Parmlt • � • — ��Q <br />BIOp. DeaL � � % --� <br />Pu01ic Worka Fee . S <br />To1al Fe� <br />LBaaAOC�FaePaltl $ ��� <br />Balence Ous S <br />r,-r�_ �i� <br />� <br />Describe Proposed Work <br />Project Address (if known) ��� <br />Ai�ach four (4) copies oi plans for praposed work - Draw to scale and note the foilowing as applicable: <br />� Property Lines ,• Centerline of street <br />� Outline and dimensions of all oxistfng and • Indlcate North <br />proposed structures on the lot • Show any proposed grading changes <br />� Existing and proposed utilities . • Show measurements <br />PERMIT CONDITIONS . <br />1. All calls (or inspectlon shall be made 24 hrs In advance - phone 259•8815. <br />2. All work shall be peAormed in accordance with this permit and currant City of Everett Design and Construction <br />Standards and Specific-.ticns <br />3. Call Location�Underground Service 48 hrs. before you d�Q. TOLL FREE NUMBER 1•800•424•5555. <br />Gf%OiP.f" To BE t�N� T-�/� i�s3�i�0✓E� �''GA.t/.S <br />,l HT�'� G -29-87 . <br />,'; F•. <br />_: <br />Approved <br />FINAL INSPECT�ON Q <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAflTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phune: 259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />♦�^ <br />V+ <br />O <br />a <br />The undersigned owner/applicaN here::.i agrees to hold and save harm- <br />less the City of Everett from any and a�l claims for damages, costs, <br />exp^nses, or causes of action that may arise because af instaltation <br />/9�. and maintenance of the improvement or other right•ohway use nereto <br />applied (or and further agrees to remove same upon nolice frorA the <br />Date City and to replace public property damaged thereby. <br />�� ��� � � � � <br />Date � p <br />Signature of A licant 2te <br />WORK AUTHORI2ED BY THIS PERMI7 MUST BE STARTED WITHIN <br />iB0 DAYS OF DATE PERMIT IS ISSUED AN� THEREAFTER IS TO <br />BE OILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAY BE <br />ChNCEL! ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />