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Date�-n r�� � <br />Application For <br />PUBL9C WARKS PERMiT <br />Print or Type ONy <br />Owner <br />Applicant <br />Describe Proposed Work ���� LL// C./� <br />Project Address (if known) <br />City <br />Attach fcur (4) copies of plans for proposed work - Draw to �cale and note the following as <br />• Froperty Lines <br />• Outline and dimensions ot all existing and <br />propo�ed structures on the lot <br />O Existing and proposed utilities <br />PUEIie Worka Permit • <br />emp. oec� • <br />Public Worka F¢e <br />Tolal Fee $ <br />Less ApO� Fes Paltl $ <br />Balanca Oue $ <br />• Centerline of street <br />• Indicate North <br />• Show any pruposed grading changes <br />• Show measurements <br />PENMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. 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 Lncation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�or �� �%�j� <br />� <br />���/2 ��a�' <br />/ <br />tor Construction <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />Tne undersigned owner/applir.ant hereby agrees to hold and save harm- � <br />less the City of Everett trom any and all claims for damages, costs, I <br />expenses, or causes ot action that may arise hecause of installation '�� <br />and mainlenance of ihe improvement or other right-ohway use hereto ' <br />applied (or and further 2nrees to remove same upon notice from the � <br />Date City and to raplace public property damaged thereby. . <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259-E815 <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERM�T IS ISSUED AND THEREAFTCR IS TO <br />BE DILIGENTLY PURSUED TO C0�4PLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIrJN. �� �- <br />